IgA肾病的中医辨证分型与病理相关性研究

目的:探讨IgA肾病的中医辨证分型与其病理的相关性。方法:回顾53例临床病例,根据中医证候诊断标准进行辨证分型,分为脾肾气虚、肝肾阴虚及气阴两虚三型,兼证外感风热、湿热内蕴、瘀血内阻。观察以上各证型与病理参数、病理分级之间的关系。结果:显示53例病人中脾肾气虚型、肝肾阴虚型、气阴两虚型三种证型比较,脾肾气虚型临床表现最轻,病理改变最轻,病理分级最低,气阴两虚型临床表现最重,病理改变最重,病理分级最高,P<0.05。结论:IgA肾病病性多属本虚标实,本虚主要是肝肾阴虚和气阴两虚,标实主要是外感、湿热、瘀血等。其病机演变规律多为气虚-阴虚-气阴两虚,且随病机演变,其临床表现、病理改变逐渐加重。

Dependability Research on Differentiation of Symptoms and Signs for Classification of Syndrome and Pathology of IgA Nephropathy

Objective:To investigate the traditional Chinese medicine(TCM) and its pathology relationship in IgA nephropathy(IgAN),so as to deduce the pathogenetic condition and prognosis,and guide the clinic therapy.Methods: 53 cases of IgAN were analyzed retrospectively,syndrome differentiations were concluded by the diagnosis criteria of TCM syndrome in the clinic research and guiding principe of the curment new herd in chronic nephritis in 2002 into deficiency of spleen and kidney qi,deficiency of liver and kidney yin,deficiency of both qi and yin,and the accompanied syndrome as affection of exogenous wind-heat,endoretention of damp-heat and blood stagnation.The relationship among pathological parameters,pathological stages and the above syndromes were observed.Results:Compared the three clinical syndromes of deficiency of spleen and kidney qi,deficiency of liver and kidney yin and deficiency of both qi and yin of 53 cases of patients,pathology change and pathological stage were the lightest in deficiency of spleen and kidney qi,on the contrary,the heaviest in deficiency of both qi and yin,P<0.05.Conclusion: Disease character of IgAN were mostly asthenia in origin and sthenia in superficiality;asthenia in origin was deficiency of liver and kidney yin and deficiency of both qi and yin;sthenia in superficiality was affection of exogenous wind-heat,endoretention of damp-heat and blood stagnation.Its pathogenesis rule mostly developed from deficiency of qi-deficiency of yin-deficiency of qi and yin,and with its development,its clinical syndrome and pathological change would get worser.