从虚、瘀、风湿论治IgA肾病123例临床分析——附69例5型辨治及65例本虚为主辨治的疗效对照

目的：优化IgA肾病（IgAN）的中医辨治方案,验证从虚、瘀、风湿3型论治IgAN的临床疗效。方法：将123例IgAN患者按虚、瘀、风湿3型辨证论治,并与5型辨治方案及本虚为主辨治方案进行历史性对比。结果：3型辨治组治后中医证候总积分、24h尿蛋白定量及尿红细胞均较治前明显减少（P〈0.01）,肾功能稳定。3型辨治组肾病理Lee’sⅠ～Ⅱ级的61例患者,临床缓解率明显优于65例本虚为主组（59.0% vs 20.0%,P〈0.01）;甚至前者62例Lee’s≥Ⅲ级的患者,其缓解率亦优于后者Lee’sⅠ～Ⅱ级的患者（45.2% vs 20.0%,P〈0.01）。3型辨治组较之5型辨治组虽然缓解率略高（Lee’sⅠ～Ⅱ：59.0% vs 57.1%;≥Ⅲ级：45.2% vs 29.3%）,但无统计学意义（P〉0.05）。结论：虚、瘀、风湿3型辨治方案更符合IgAN的证候谱、病机及其演变规律,具有执简御繁、实用有效的优点。

Study on the therapy based on tonifying deficiency,resolving blood stasis,and dispelling wind-dampness of IgA nephropathy in 123 cases

Objective： To improve and testify the Traditional Chinese Medicine （TCM） treatment according to the syndrome manifestations of Deficiency, Blood Stasis, and Wind - dampness in IgA Nephropathy（ IgAN）. Methods： Group A （ 123 IgAN patients） were treated with the therapy according to three- types- syndromes analysis （deficiency, blood stasis, and wind- dampness） ;group B （69 patients） that were treated with the therapy according to the former five - types- syndromes analysis（deficiency, blood stasis, wind- dampness, wind - heat, and damp - heat） ;and group C （65 patients） were treated only by Tonifying Deficiency. Results：The scores of TCM syndromes index, proteinuria and hematuria levels in patients of group A decreased significantly, and renal function was stable. Sixty- one patients of this group, whose kidney pathological changes were in level Ⅰ-Ⅱ （Lee＇ s） ,obtained a better curative effect than the patients in group C（ the clinical cure rate were 59.0 % vs 20.0 %, P〈 0.01 ）. And other 62 patients in group A, whose kidney pathological changes even reached over level Ⅲ, also got a better clinical cure rate more than those patients whose pathological changes were only in level Ⅰ - Ⅱ in group C （the clinical cure rate were 45.2% vs 20.0% ,P〈0.01）. Though the cure rate in group A was also higher than the rate in group B, it was insignificant in statistics. Conclusion： The therapy based on Tonifying Deficiency, Resolving Blood Stasis, and Dispelling Wind - dampness is more suitable to IgAN than other former TCM analysis and treatments. It is good for carrying out and getting efficiency.