【摘要】 目的:探讨IgA肾病中医辨证分型与临床指标之间的相关性。方法:选取我院IgA肾病患者60例作为研究对象,研究本组患者中医辨证分型与临床指标之间的相关性。据2002年《中药新药临床研究指导原则》中慢性肾炎中医辨证标准对本组患者进行辨证分析,内容包括脾肾气虚、肝肾阴虚、气阴两虚型,兼证则包括外感风热、湿热内蕴、瘀血内阻。清晨空腹抽取患者静脉血检测血肌酐、血白蛋白、血甘油三酯、血胆固醇及24h尿蛋白,并进行病理分级。分析IgA肾病中医辨证分型与临床症状之间的关系、中医辨证分型与临床指标的关系及病理分级的关系。结果:中医症候分型可知60例患者中脾肾气虚14例、肝肾阴虚11例、气阴两虚型35例。脾肾气虚患者轻中度蛋白尿发生率最高,其次是镜下血尿。肝肾阴虚型患者镜下血尿发生率最高,其次是肉眼血尿。气阴两虚型患者肉眼血尿发生率最高,其次是轻中度蛋白尿。三种中医症候患者的肉眼血尿、镜下血尿、轻中度蛋白尿发生率差异比较有统计学意义(P<0.05),大量蛋白尿发生率差异比较无统计学意义(P>0.05)。脾肾气虚、肝肾阴虚、气阴两虚型患者血肌酐、24h蛋白尿、血白蛋白、血甘油三酯、血胆固醇水平差异比较有统计学意义(P<0.05)。气阴两虚患者的血肌酐、血胆固醇水平最高,肝肾阴虚患者血甘油三酯水平最高,脾肾气虚患者血白蛋白水平最高。病理分级结果可知Ⅰ级9例,Ⅱ级21例,Ⅲ级14例,Ⅳ级5例,Ⅴ级1例。脾肾气虚型中病理Ⅰ级率最高,肝肾阴虚中Ⅱ级率最高,气阴两虚中Ⅲ级、Ⅳ级、Ⅴ级率较高。三组Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级、Ⅴ级率差异比较有统计学意义(P<0.05)。结论:脾肾气虚、肝肾阴虚、气阴两虚型IgA肾病患者临床症状表现各异,且临床指标有规律。气阴两虚型患者病情最严重,其次是肝肾阴虚患者,脾肾气虚患者病情最轻,提醒临床辨证治疗。更多还原

【Abstract】 Objective:To investigate the correlation between TCM syndrome differentiation and clinical indicators of IgA nephropathy.Methods:60 cases of IgA nephropathy were analyzed, and the TCM syndrome differentiation types were classified according to the diagnosis criteria of TCM syndrome in the clinic research and guiding principle of the new drug treatment in chronic nephritis in 2002, including spleen and kidney qi deficiency, liver and kidney Yin deficiency and qi and Yin deficiency, and the accompanied syndrome as affection of exogenous wind-heat, endoretention of damp-heat and blood stagnation. The serum creatinine, albumin, triglyceride, cholesterol and 24 hour urinary protein in fasting venous blood were measured, and pathological grading was performed. Then the relationship among TCM syndrome differentiation, clinical indicators and the pathological grading was also determined. Results:According to TCM syndrome classification, there were 14 cases of spleen and kidney qi deficiency, 11 cases of liver and kidney Yin deficiency and 35 cases of qi and Yin deficiency. The incidence of mild to moderate proteinuria was the highest in patients with spleen and kidney qi deficiency, followed by microscopic hematuria. The incidence of microscopic hematuria was the highest in patients with Yin deficiency of liver and kidney,followed by gross hematuria. The incidence of gross hematuria was the highest in patients with deficiency of both qi and Yin, followed by mild and moderate proteinuria. The incidence rate of gross hematuria, microscopic hematuria and mild to moderate proteinuria among the three TCM symptoms had statistic difference(P<0.05), while the incidence of massive proteinuria had no difference(P>0.05). The serum creatinine, 24 hour proteinuria, serum albumin, triglyceride and cholesterol levels had statistic difference between the deficiency of spleen and kidney qi, deficiency of liver and kidney Yin and deficiency of both qi and Yin(P<0.05). The levels of serum creatinine and cholesterol were the highest in patients with deficiency of both qi and Yin. The levels of triglyceride in patients with deficiency of liver and kidney Yin were the highest, and the levels of albumin in patients with deficiency of spleen and kidney qi were the highest. Pathological grading results showed that there were 9 grade I patients, 21 grade II patients, 14 grade III patients, 5 grade IV patients and 1 grade V patients.The pathological grade I rate was the highest in patients with spleen-kidney deficiency, the grade II rate was the highest in pa-tients with liver-kidney deficiency, and the grade III, IV and V rates were higher in patients with qi-Yin deficiency. The differences in the rates of grade I, II, III, IV and V among the three groups were statistic(P<0.05). Conclusion:IgA nephropathy patients with spleenkidney qi deficiency, liver-kidney Yin deficiency and qi-Yin deficiency have different clinical symptoms and regular clinical indicators.The condition of patients with qi and Yin deficiency is the most serious, followed by liver and kidney Yin deficiency, and spleen and kidney qi deficiency is the lightest, which is a reminder of clinical dialectical treatment.更多还原