CAJ | 학술논문

目的：探讨原发性IgA肾病中医邪实证候与西医临床及实验室指标的相关性。方法采用前瞻性研究方法，联合多家医院收集临床及实验室资料，遵循中医证候诊断标准确定证候类型，分析266例IgA肾病患者中医邪实证候与西医临床及实验室指标的相关性。结果邪实证候与临床分型关系中，风热候肉眼血尿型多见，痰湿候肾病综合征型多见，湿热候慢性肾炎Ⅰ型多见，瘀血候慢性肾炎Ⅱ型多见。邪实证候与临床表现关系中，瘀血候高血压的发生率最高，风热候血尿程度最重，痰湿候大量蛋白尿的发生率最高。邪实证候与实验室指标关系中，痰湿候尿蛋白定量高于风热候和湿热候，血白蛋白明显低于其他3个证候；瘀血候血肌酐明显高于其他3个证候，估计肾小球滤过率低于其他3个证候；痰湿候血胆固醇和三酰甘油分别高于其他3个证候；痰湿候和瘀血候部分凝血酶原时间低于风热候和湿热候，纤维蛋白原高于风热候和湿热候。邪实证候与慢性肾脏病(CKD)分期关系中，风热候以CKD1期居多，瘀血候以CKD3期多见。结论 IgA肾病中医邪实证候与西医临床及实验室指标具有一定相关性，西医临床及实验室指标对弥补传统中医四诊信息量的不足、提高中医辨证准确率具有一定参考价值。
목적：탐토원발성IgA신병중의사실증후여서의림상급실험실지표적상관성。방법채용전첨성연구방법，연합다가의원수집림상급실험실자료，준순중의증후진단표준학정증후류형，분석266례IgA신병환자중의사실증후여서의림상급실험실지표적상관성。결과사실증후여림상분형관계중，풍열후육안혈뇨형다견，담습후신병종합정형다견，습열후만성신염Ⅰ형다견，어혈후만성신염Ⅱ형다견。사실증후여림상표현관계중，어혈후고혈압적발생솔최고，풍열후혈뇨정도최중，담습후대량단백뇨적발생솔최고。사실증후여실험실지표관계중，담습후뇨단백정량고우풍열후화습열후，혈백단백명현저우기타3개증후；어혈후혈기항명현고우기타3개증후，고계신소구려과솔저우기타3개증후；담습후혈담고순화삼선감유분별고우기타3개증후；담습후화어혈후부분응혈매원시간저우풍열후화습열후，섬유단백원고우풍열후화습열후。사실증후여만성신장병(CKD)분기관계중，풍열후이CKD1기거다，어혈후이CKD3기다견。결론 IgA신병중의사실증후여서의림상급실험실지표구유일정상관성，서의림상급실험실지표대미보전통중의사진신식량적불족、제고중의변증준학솔구유일정삼고개치。
Objective To explore the relationship between traditional Chinese medicine (TCM) syndromes of state of evil domination and clinical and laboratory indicators of IgA nephropathy. Methods A prospective study was used to collect data on clinical and laboratory examination of IgA nephropathy in multi clinical centers. Patients’ TCM syndrome types were determined according to the national diagnostic criteria at the same time. Totally 266 patients with IgA nephropathy were included in the study to establish a database for analyzing the relationship between TCM syndrome of state of evil domination and clinical and laboratory indicators. Results In the relationship between syndromes of state of evil domination distribution and clinical subtypes, patients of wind-heat syndrome had more macroscopic hematuria;patients of phlegm-damp syndrome had more nephrotic syndrome;patients of damp-heat syndrome had more chronic nephritis type Ⅰ;patients of blood stasis syndrome had more chronic nephritis type Ⅱ. In the relationship between syndrome of state of evil domination distribution and clinical manifestation, the incidence of hypertension was higher in patients of blood stasis syndrome than in other three types. It was more serious for hematuresis in the patients of wind-heat syndrome. For patients of phlegm-damp syndrome, the incidence of heave proteinuria was highest. In the relationship between syndrome of state of evil domination distribution and laboratory examination, 24-hour urinary protein quantification was higher than in patients of wind-heat and damp-heat syndrome, but the level of blood albumin was lowest. For patients of blood stasis syndrome, serum creatinine level was significantly higher than in other three types;the level of eGFR was just the opposite. The levels of blood cholesterol and triglyceride in patients of phlegm-damp syndrome were higher than in other three types. The activated partial thromboplastin time (APTT) levels in patients of blood stasis and phlegm-damp syndrome were lower than in other patients, but the FIB level was the exact opposite of APTT. In the relationship between syndrome of state of evil domination distribution and the stages of chronic kidney disease (CKD), patients of wind-heat syndrome were more in the first stage of CKD;patients of blood stasis syndrome were more in the third stage of CKD. Conclusion There is relative correlation between TCM syndromes of state of evil domination and clinical and laboratory indicators in IgA nephropathy, which would provide some reference to narrow the gap in the information of the four methods of TCM with clinical and laboratory indicators to enhance accurate diagnosis of TCM syndrome.