CAJ | 학술논문

目的：探讨IgA肾病中医证型分布规律及其与西医临床、牛津病理的关系。方法收集上海交通大学医学院附属仁济医院确诊的IgA肾病患者108例，根据临床症候进行传统中医辨证，收集实验室检查、肾脏病理等资料，分析中医辨证分型与牛津病理关系。结果108例IgA肾病患者中医证型分为脾肾气虚36例（33．3％）、气阴两虚证40例（37．0％）、肝肾阴虚症25例（23．1％），脾肾阳虚证7例（6．5％）。气阴两虚、脾肾阳虚证以肉眼血尿多见，肝肾阴虚和脾肾阳虚证以高血压、肾功能不全多见。脾肾气虚、气阴两虚患者Lee氏分级较轻，以III 级为主（61．1％和67．5％）；肝肾阴虚分级较重，以III～IV级为主（92．0％）；脾肾阳虚Lee氏分级最重，以IV～V级为主（100％）。辨证分型与Lee氏分级显著相关（ r ＝0．28， P ＜0．01）。内皮细胞增生（E）在气阴两虚证（20．0％）、脾肾阳虚证（28．6％）所占比例高于脾肾气虚证（2．8％）、肝肾阴虚证（8．0％）；肾小管萎缩或间质纤维化（T1／T2）在脾肾阳虚证所占比例最高（100％），其次为肝肾阴虚证（64．0％），脾肾气虚证（25．0％）与气阴两虚症（30．0％）所占比例较低。脾肾阳虚证的牛津病理总积分最高为（12．57±2．51）分，其次为肝肾阴虚证（7．72±4．88）分，脾肾气虚证（4．05±3．79）分与气阴两虚证（5．08±3．91）分间差异无统计学意义（ P ＞0．05）。中医证型与牛津病理总积分显著相关（ r ＝0．470， P ＜0．01）。脾肾阳虚证出现肾小球硬化的比例显著高于气阴两虚证（ P ＜0．05）；气阴两虚证与肝肾阴虚证新月体出现的比例显著高于脾肾气虚证。结论 IgA肾病中医证型与牛津病理组织学改变及病变程度显著相关，中医临床辨证分型对预测肾脏病理改变程度有一定的参考价值。目的：探討IgA腎病中醫證型分佈規律及其與西醫臨床、牛津病理的關繫。方法收集上海交通大學醫學院附屬仁濟醫院確診的IgA腎病患者108例，根據臨床癥候進行傳統中醫辨證，收集實驗室檢查、腎髒病理等資料，分析中醫辨證分型與牛津病理關繫。結果108例IgA腎病患者中醫證型分為脾腎氣虛36例（33．3％）、氣陰兩虛證40例（37．0％）、肝腎陰虛癥25例（23．1％），脾腎暘虛證7例（6．5％）。氣陰兩虛、脾腎暘虛證以肉眼血尿多見，肝腎陰虛和脾腎暘虛證以高血壓、腎功能不全多見。脾腎氣虛、氣陰兩虛患者Lee氏分級較輕，以III 級為主（61．1％和67．5％）；肝腎陰虛分級較重，以III～IV級為主（92．0％）；脾腎暘虛Lee氏分級最重，以IV～V級為主（100％）。辨證分型與Lee氏分級顯著相關（ r ＝0．28， P ＜0．01）。內皮細胞增生（E）在氣陰兩虛證（20．0％）、脾腎暘虛證（28．6％）所佔比例高于脾腎氣虛證（2．8％）、肝腎陰虛證（8．0％）；腎小管萎縮或間質纖維化（T1／T2）在脾腎暘虛證所佔比例最高（100％），其次為肝腎陰虛證（64．0％），脾腎氣虛證（25．0％）與氣陰兩虛癥（30．0％）所佔比例較低。脾腎暘虛證的牛津病理總積分最高為（12．57±2．51）分，其次為肝腎陰虛證（7．72±4．88）分，脾腎氣虛證（4．05±3．79）分與氣陰兩虛證（5．08±3．91）分間差異無統計學意義（ P ＞0．05）。中醫證型與牛津病理總積分顯著相關（ r ＝0．470， P ＜0．01）。脾腎暘虛證齣現腎小毬硬化的比例顯著高于氣陰兩虛證（ P ＜0．05）；氣陰兩虛證與肝腎陰虛證新月體齣現的比例顯著高于脾腎氣虛證。結論 IgA腎病中醫證型與牛津病理組織學改變及病變程度顯著相關，中醫臨床辨證分型對預測腎髒病理改變程度有一定的參攷價值。
목적：탐토IgA신병중의증형분포규률급기여서의림상、우진병리적관계。방법수집상해교통대학의학원부속인제의원학진적IgA신병환자108례，근거림상증후진행전통중의변증，수집실험실검사、신장병리등자료，분석중의변증분형여우진병리관계。결과108례IgA신병환자중의증형분위비신기허36례（33．3％）、기음량허증40례（37．0％）、간신음허증25례（23．1％），비신양허증7례（6．5％）。기음량허、비신양허증이육안혈뇨다견，간신음허화비신양허증이고혈압、신공능불전다견。비신기허、기음량허환자Lee씨분급교경，이III 급위주（61．1％화67．5％）；간신음허분급교중，이III～IV급위주（92．0％）；비신양허Lee씨분급최중，이IV～V급위주（100％）。변증분형여Lee씨분급현저상관（ r ＝0．28， P ＜0．01）。내피세포증생（E）재기음량허증（20．0％）、비신양허증（28．6％）소점비례고우비신기허증（2．8％）、간신음허증（8．0％）；신소관위축혹간질섬유화（T1／T2）재비신양허증소점비례최고（100％），기차위간신음허증（64．0％），비신기허증（25．0％）여기음량허증（30．0％）소점비례교저。비신양허증적우진병리총적분최고위（12．57±2．51）분，기차위간신음허증（7．72±4．88）분，비신기허증（4．05±3．79）분여기음량허증（5．08±3．91）분간차이무통계학의의（ P ＞0．05）。중의증형여우진병리총적분현저상관（ r ＝0．470， P ＜0．01）。비신양허증출현신소구경화적비례현저고우기음량허증（ P ＜0．05）；기음량허증여간신음허증신월체출현적비례현저고우비신기허증。결론 IgA신병중의증형여우진병리조직학개변급병변정도현저상관，중의림상변증분형대예측신장병리개변정도유일정적삼고개치。
Objective To investigate the distribution pattern of TCM syndrome type and its relationship with the Ox-ford classification renal pathology in patients with IgA nephropathy.Methods One hundred and eight patients with IgA ne-phropathy diagnosed in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine were collected.Patients’ s TCM syndrome type was differentiated according to their clinical manifestations, data concerning laboratory examination and Oxford classification renal pathology.Results The highest probability (37.0%) was found in Qiyinliangxu syndrome (40 ca-ses), followed by Pishenqixu syndrome (33.3%, 36 cases), Ganshenyinxu (23.1%, 25 cases), Pishenyangxu (6.5%, 7 cases) .Hypertension and renal deficiency were common in Pishenyinxu syndrome and Pishenyangxu syndrome.Ganshenyinxu and Pishenyangxu were more likely with renal hypertension.Pishenqixu, Qiyinliangxu patients’ Leeˊs classification were re-vealed lighter, mainly was level III (61.1%and 67.5%);Ganshenyinxu revealed heavy of classification, from level III to IV (92.0%);Pishenyangxu’s Lee’ s grading was the worst, from level IV to V (100%).Syndrome differentiation and Lee grading was significantly correlated ( r =0.28, P <0.01).The proliferation of endothelial cells (E) in Qiyinliangxu syn-drome (20.0%), Pishenyangxu (28.6%) were higher than the proportion of Pishenqixu (2.8%) and Ganshenyinxu syn-drome (8.0%);renal tubular atrophy and interstitial fibrosis (T1/T2) in the Pishenyangxu accounted for the highest propor-tion (100%), Ganshenyinxu syndrome (64.0%),Pishenqixu (25.0%) and Qiyinliangxu syndrome (30.0%) accounted for a lower proportion.The Pishenyangxu syndrome’s Oxford total pathological score was the highest (12.57 ±2.51),followed by Ganshenyinxu syndrome (7.72 ±4.88), Pishenqixu (4.05 ±3.79) and Qiyinliangxu syndrome (5.08 ±3.91), there was no significant difference among them ( P >0.05).TCM syndrome types and pathological score was significantly related to Oxford score ( r =0.470, P <0.01).Pishenliangxu’s glomerular sclerosis rate was significantly higher than that of Qiyinlia-ngxu syndrome ( P <0.05);the ratio crescent in Qiyinliangxu syndrome and Ganshenyinxu syndrome were significantly high-er than that of Pishenliangxu.Conclusion Prospective study proves that the TCM syndrome type of patents with IgA nephrop-athy is correlated with the grade and severity of Oxford renal pathological changes.The syndrome types of TCM have a certain reference value for the prediction of renal pathological changes.