TCM Syndromes And Pathological Classification And Clinical Characteristics Analysis With Lupus Nephritis

ObjectiveSystemic lupus erythematosus is a systemic autoimmune connective tissue disease.Through its own combination of antigens and antibodies formed by the deposition of immune complexes,lead to the kidneys,joints,heart,lung,skin and other multi-site,multi-system injury.Lupus nephritis is one of the main cause of death in SLE patients.According to the results of renal biopsy,kidney involvement is up to 90%.Chinese and Western Medicine have made the effect more satisfactory.In order to improve the therapeutic effect,we study the distribution pattern of TCM Syndrome type and its relationship with clinical indexes and renal pathology in patients with lupus nephritis.To provide a scientific basis,We conjecture the degree of renal pathology through TCM Syndrome and clinical features.MethodPatients TCM Syndromes were differentiated according to their clinical manifestations,date concerning laboratory examination and renal pathology were collected to establish a database for analyzing the relationship among TCM syndromes,clinical indexes and renal pathology in 40 patients.Renal pathology scoring systems of the NIH activity index(AI),chronicity index (CI) and of the global activity index(GAI),chronic lesions index(CLI), the tubulointerstitial activity index(TIAI) and the Immunofluorescence index(IFI) of the biopsy index(BI):The AI and CI were graded on a scale of 0,1,2,or 3,as described in previous publications,representing the spectrum of no lesions,up to 25%,25 - 50%,or >50%of the component affected, respectively.Items 3 and 5 of the AI are weighted by a factor of 2.The maximum AI and CI scores are 24 and 12,respectively.The score of the BI consists of the sum of the GAI,TIAI,CLI.The original BI also consists of an immunofluorescence index(IFI) with scores glomerular capillary,glomerular mesangial,tubulointerstitial and vascular mmunofluorescence staining activity.The GAI,TIAI and CLI were graded on a scale of 0,0.5,1,2 or 3, as described by the original publication.A score of 0.5 was given if lesions were present in less than 5-10%of the component studied,otherwise grading was similar to that of the NIH index.Items 3 and 5 of the GAI are also weighted by a factor of 2,similarly to the AI.The maximum GAI,TIAI and CLI IFI scores are 24,21,15 and 96 respectively.ResultsAmong the syndrome of root cause of 40 patients,27cases(67.5%) were differentiated as syndrome of qi deficiency of spleen and kidney,lOcases (25.0%) were differentiated as syndrome of deficiency of both qi and yin, 2cases(5.0%) were differentiated as syndrome of yang deficiency of spleen and kidney,and 1case(2.5%) were differentiated as syndrome of yin deficiency of liver and kidney;The pathology types of syndrome qi deficiency of spleen and kidney were IV type(59.3%),III type(14.8%),Vtype(14.8%),and the pathology types of syndrome not-qi deficiency of spleen and kidney were IV type(53.8%),IIItype(30.8%).Among syndrome of manifestation,8cases(10.8%) were differentiated as syndrome of fluid-dampness,25cases(33.8%) were differentiated as syndrome of dampness-heat,27cases(36.5%) were differentiated as syndrome of blood stasis,and 14cases(18.9%) were differentiated as syndrome of dampness-phlegm.The pathology types of syndrome of fluid-dampness were IV type(75.0%),and syndrome of dampness-heat were IVtype(56.0%),IIItype(16.0%),Vtype(16.0%),and syndrome of blood stasis were IVtype(55.6%),IIItype(22.2%),and syndrome of dampness-phlegm were IV type(71.4%).ESR,APTT,and 24hpro were significantly different among syndrome of root cause as syndrome of qi deficiency of spleen and kidney and syndrome of not-qi deficiency of spleen and kidney.APTT were significantly different among syndrome of manifestation as syndrome of fluid-dampness and syndrome of dampness and phlegm HGB of syndrome of fluid-dampness and syndrome of dampness and phlegm is lower than normal,and HGB of syndrome of fluid-dampness was significantly lower than syndrome of blood stasis and syndrome of dampness-heat.Besides,there was significant difference among syndrome of manifestation as dampness phlegm and others with Scr.BUN of syndrome of dampness phlegm was significantly higher than syndrome of blood stasis and syndrome of dampness-heat.TCH of syndrome of fluid-dampness was significantly higher than syndrome of blood stasis.Clinic indexes of syndrome of fluid-dampness was significant lower than other syndromes of manifestation. CI,NIH of syndrome of dampness phlegm was significantly higher than syndrome of blood stasis.ConclusionTCM Syndrome type of patients with Lupus Nephritis is significantly correlated with the clinical indexes and the severity of their renal pathological changes,thus,the TCM Syndrome typing shows definite referential importance to conclude the clinical indexes and the severity of pathological changes in patients with LN.