286例IgA肾病中医辨证与肾脏病理关系的多中心前瞻性研究

目的：探讨IgA肾病中医证型分布规律及其与西医临床病理关系。方法：采用多中心协作研究的方法，根据临床表现进行传统的中医辨证，收集实验室检查、肾脏病理等资料，建立数据库，分析286例IgA肾病患者中医辨证分型与病理关系。结果：脾肺气虚、气阴两虚证病理变化较轻，Lee分级以I～Ⅲ级为主(72．3％，70．2％)；肝肾阴虚证病理变化较重，以Ⅲ～Ⅳ级为主(84．6％)；脾肾阳虚证病理变化最重，以Ⅳ～V级为主(88．0％)。辨证分型与Lee分级相关显著(r=0．26，P<0．01)。脾肾阳虚证球性硬化比率明显高于脾肺气虚、气阴两虚及肝肾阴虚证。按病变程度进行半定量积分，脾肾阳虚证总积分、肾小球、肾小管-间质、血管积分明显高于其他3个中医证型；肝肾阴虚证总积分、肾小球、肾小管-间质积分及血管积分明显高于脾肺气虚证；肝肾阴虚证总积分、肾小管-间质和血管积分高于气阴两虚证。脾肺气虚与气阴两虚证两组之间积分无明显差异。结论：经多中心前瞻性研究证明，IgA肾病中医辨证分型与IgA肾病病理分级及病变程度显著相关，中医临床辨证分型对推测肾脏病理改变程度有一定的参考价值。

Multicenter Prospective Study on Relationship of TCM Syndrome Type and Renal Pathology in 286 Patients with IgA Nephropathy

OBJECTIVE: To study the distribution pattern of TCM Syndrome type and its relationship with renal pathology in patients with IgA nephropathy. METHODS: Apopting multicenter coordinated method, patients' TCM Syndrome type was differentiated according to their clinical manifestations, data concerning laboratory examination and renal pathology were collected to establish a database for analyzing the relationship between TCM Syndrome type and renal pathology in 286 patients. RESULTS: Patients of Pi-Fei Qi-deficiency type (type 1) and both Qi-Yin deficiency type (type 2) showed rather milder pathological changes, by Lee classification, most of them belonged to grade I-III (72.3%, 70.2%); patients of Gan-Shen Yin deficiency type (type 3) had severe pathological change and majority of them belonged to grade III-IV (84.6%); and the most severe pathological change was shown in patients of Pi-Shen Yang-deficiency type (type 4), and the Lee's grade IV-V was dominant (88.0%) in them. Syndrome type of patients was significantly correlated with their Lee's grade (r = 0.26, P < 0.01). Percentage of glomerular sclerosis in patients of type 4 was higher than that in patients of the other three types. Semi-quantitative scoring upon pathological changes showed that the total, glomerular, tubulo-interstitial and vascular scores were significantly higher in patients of type 4 than in those of the other three types; those scores were higher in patients of type 3 than in type 1; the total, glomerular and vascular scores were higher in patients of type 3 than in type 2; and scores in patients of type 1 and type 2 showed insignificant difference. CONCLUSION: Multicentric prospective study proves that the TCM Syndrome typeof patients with IgA nephropathy is significantly correlated with the grade and severity of their renal pathological changes, thus, the TCM Syndrome typing shows definite referential importance to conclude the severity of renal pathological change in patients with IgA nephropathy.