原发性IgA肾病中医邪实证候与西医临床指标相关性研究

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。

A Relevant Research on the Relationship Between TCM Syndromes of State of Evil Domination and Clinical Indicators in IgA Nephropathy

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 i