IgA肾病中医证型与临床预后指标的相关性分析

目的探讨IgA肾病中医证型的分布规律及中医证型与主要预后指标的关系,为中西医结合诊治本病的规范化提供依据。方法采用流行病学回顾性调查方法,收集156例IgA肾病患者的中医证候学及实验室检查资料,根据《慢性肾炎中医辨证标准》进行辨证分型,探讨中医证型的分布规律及与主要预后指标的关系。结果肝肾（气）阴虚证81例（51.92%）,其次为阴阳两虚证56例（35.90%）和脾肾（气）阳虚证19例（12.18%）;随着年龄的增长,肝肾阴（气）虚证的比例呈下降趋势,脾肾（气）阳虚证的比例呈上升趋势;脾肾（气）阳虚证的大量蛋白尿、高血压、肾功能损害、高尿酸血症的发生概率显著高于阴阳两虚证与肝肾（气）阴虚证（P〈0.05,P〈0.01）,且脾肾（气）阳虚证的尿蛋白、血压、血肌酐、血尿酸水平均高于阴阳两虚证与肝肾（气）阴虚证（P〈0.05,P〈0.01）;阴阳两虚证中各因素的发生概率及数值均高于肝肾（气）阴虚证（P〈0.05,P〈0.01）。结论肝肾（气）阴虚证是IgA肾病的主要中医证型,中医证型与蛋白尿、高血压、肾功能损害、高尿酸血症等预后指标密切相关。

Correlativity between Chinese medical syndromes and clinical prognosis of IgA nephropathy

Objective To investigate the distribution law of Chinese medical syndromes and their correlativity with prognosis of IgA nephropathy.Methods Epidemiological retrospective survey was conducted to collect the information of 156 IgA nephropathy patients,including Chinese medical syndromes and laboratory findings,in an attempt to find out the relation between the syndrome and laboratory findings.Results Liver-kidney yin deficiency syndrome happened in 81 cases（51.92%）,yin-yang deficiency syndrome in 56 cases（35.90%） and spleen-kidney yang deficiency syndrome in 19 cases（12.18%）;with the increase of age,liver-kidney yin deficiency syndrome happened less,and spleen-kidney yang deficiency syndrome more.The probability of substantive proteinuria,hypertension,renal dysfunction and hyperuricemia was higher in spleen-kidney yang deficiency syndrome than in liver-kidney yin deficiency syndrome and yin-yang deficiency syndrome（P〈0.05,P〈0.01）;and the levels of urinary protein,blood pressure,serum creatinine and serum uric acid was higher in spleen-kidney yang deficiency syndrome than in liver-kidney yin deficiency syndrome and yin-yang deficiency syndrome（P〈0.05,P〈0.01）;and the probability and levels were higher in yin-yang deficiency syndrome than in liver-kidney yin deficiency syndrome（P〈0.05,P〈0.01）.Conclusion Liver-kidney yin deficiency syndrome is the principal one of IgA nephropathy,and closely related to such prognostic indexes as urine protein,hypertension,renal injury and hyperuricemia.