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174例原发性肾小球疾病患者血瘀证、临床特征与肾脏病理的相关性分析

[Correlation analysis on blood stasis syndrome, clinical features and renal pathology in 174 patients with primary glomerular diseases].

作者信息

Li Shen, Wang Su-xia, Rao Xiang-rong

机构信息

Department of Nephrology, First Hospital of Peking University, Beijing.

出版信息

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2007 Jun;27(6):487-91.

Abstract

OBJECTIVE

To investigate the relationship between degree of TCM blood-stasis syndrome (BSS) with clinic features and renal pathological type of primary glomerular disease (PGD).

METHODS

On-site investigation was adopted, 174 patients with PGD conforming to the inclusive/exclusive criteria were enrolled, and their degree of BSS and deficiency syndrome were scored in 3 days before renal biopsies. The relation of clinical indexes, including age, course of disease, symptoms of deficiency syndrome, 24-h urinary protein excretion (Upro), condition of hypertension and its controlling, glomerular filtrating rate (GFR) based on the predigesting equation of MDRD, and blood levels of uric acid (UA), triglyceride (TG), cholesterol (CHO), hemoglobin (Hb), and albumin (ALB), with the renal pathological type and the BSS score were analyzed.

RESULTS

(1) Among the 174 patients, 159 cases (91.38%) were differentiated as BSS, with the degree of moderate in 111 cases and severe in 48 cases; (2) The BSS score was significantly correlated with the level of Upro, CHO, TG, ALB and deficiency syndrome (P < 0.01), but showed insignificant correlation with age, course of disease, grade of the hypertension, and GFR, UA and Hb levels. Multivariate stepwise regression analysis showed that the level of Upro and TG and score of deficiency syndrome had significance for regression equation establishment (P<0.01). (3) Further analysis on renal pathological type in 119 patients of non-nephrotic syndrome showed that the BSS score was insignificantly different among patients with different renal pathological types as the minor/minimal type (3 cases), the focal/segmental glomerular type (72 cases), and the diffuse glomerulonephritis (44 cases, P > 0.05). Further stratified analysis on the 72 cases with focal/segmental lesion showed that BSS score in patients of focal proliferative sclerosing glomerulonephritis were significantly higher than that in those of focal proliferative glomerulonephritis (P < 0.01).

CONCLUSION

BSS is a TCM syndrome most commonly seen in patients with primary glomerular disease, BSS score is significantly correlated with the level of Upro, TG and deficiency syndrome score, and exhibits a higher level in patients with focal proliferative glomerulonephritis accompanying glomerulus sclerosis, indicating that the BSS could give certain clues of the renal chronic changes of primary glomerular disease, being one of risk factors in TCM syndrome in the development of renal diseases.

摘要

目的

探讨原发性肾小球疾病(PGD)中医血瘀证程度与临床特征及肾脏病理类型的关系。

方法

采用现场调查法,纳入符合纳入/排除标准的174例PGD患者,于肾活检前3天对其血瘀证及虚证程度进行评分。分析年龄、病程、虚证症状、24小时尿蛋白排泄量(Upro)、高血压情况及其控制情况、基于简化MDRD方程的肾小球滤过率(GFR)以及血尿酸(UA)、甘油三酯(TG)、胆固醇(CHO)、血红蛋白(Hb)和白蛋白(ALB)水平等临床指标与肾脏病理类型及血瘀证评分的关系。

结果

(1)174例患者中,159例(91.38%)辨证为血瘀证,其中中度111例,重度48例;(2)血瘀证评分与Upro、CHO、TG、ALB水平及虚证程度显著相关(P<0.01),但与年龄、病程、高血压分级、GFR、UA及Hb水平无显著相关性。多因素逐步回归分析显示,Upro、TG水平及虚证评分对回归方程建立有意义(P<0.01)。(3)对119例非肾病综合征患者的肾脏病理类型进一步分析显示,微小病变/轻微病变型(3例)、局灶节段性肾小球病变型(72例)和弥漫性肾小球肾炎型(44例)患者的血瘀证评分差异无统计学意义(P>0.05)。对72例局灶节段性病变患者进一步分层分析显示,局灶增生硬化性肾小球肾炎患者的血瘀证评分显著高于局灶增生性肾小球肾炎患者(P<0.01)。

结论

血瘀证是原发性肾小球疾病患者最常见的中医证型,血瘀证评分与Upro、TG水平及虚证评分显著相关,在伴有肾小球硬化的局灶增生性肾小球肾炎患者中水平较高,提示血瘀证可为原发性肾小球疾病肾脏慢性病变提供一定线索,是肾脏病发展过程中中医证型的危险因素之一。

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