Correlation Analysis Of Tcm Syndrome Types,clinical And Pathological Characteristics Of Primary IgA Nephropathy With Different Levels Of Complement C3 Deposition

ObjectiveBy retrospectively analyzing the clinical data of patients with pathologically confirmed primary Ig AN,To discuss the TCM symptoms,clinical and pathological characteristics of Ig AN with different levels of complement C3 deposition.MethodsA retrospective study was conducted to collect medical records of patients aged ≥16years old with primary Ig AN by pathological biopsy and no less than 9 glomeruli under light microscope from August 2013 to December 2020 through the Jiahe Medical Record System of the First Affiliated Hospital of Guang zhou University of Chinese Medicine.Contents include: gender,age,predisposing factors,underlying diseases(whether combined with hypertension),first symptom(edema,asymptomatic physical e x a m i n a t i o n,g r o s s h e m a t u r i a,waist discomfort,fatigue),systolic blood pressure,diastolic blood pressure,hemoglobin,24-hour urinary protein quantification,blood creatinine,blood urea nitrogen,blood uric acid,blood total cholesterol(CHOL),blood triglyceride(TG),blood low density lipoprotein(LDL),Blood glucose,albumin,serum C3,urine red blood cell count,renal pathological results,four diagnostic data of traditional Chinese medicine,etc.According to the intensity of C3 deposition in mesangial area,they were divided into four groups: negative group(group A)with no complement C3 deposition,weak positive group(group B)with a small amount of complement C3 deposition(++),positive group(group C)with moderate amount of complement C3 deposition(++),and strong positive group(group D)with large amount of complement C3 deposition(+++).To analyze the TCM syndrome distribution characteristics,clinical manifestations and renal pathological characteristics of Ig AN with different complement C3 deposition intensities.Results1.General conditions: A total of 144 eligible Ig AN patients were collected,of which28 were in the negative group(group A),accounting for 19.4% in all;Weak positive group(group B)had 31 cases,accounting for 21.5%;The positive group(group C)had 69 cases,accounting for 47.9%;There were 16 cases in the strong positive group(group D),accounting for 11.1%.there were 66 males and 78 females,male: female =0.85:1.In general conditions,there was no significant difference in gender,age,course of disease,systolic blood pressure,diastolic blood pressure,and predisposing factors between different intensity of complement C3 deposition groups.2.Traditional Chinese Medicine Syndromes: The top ten TCM symptoms of Ig AN in this study are microscopic hematuria(16.91%),foamed urine(11.99%),poor sleep(6.08%),fatigue(5.42%),dry mouth and bitter taste(5.09%),edema of both lower limbs(4.93%),and anorexia(3.78%).The main syndromes are spleen and kidney yang deficiency syndrome and liver and kidney yin deficiency syndrome,while the accompanying syndromes are damp-heat syndrome and water-dampness syndrome.There is no significant difference in TCM syndrome classification between different levels of complement C3 deposition groups.3.Clinical data: Edema is the most common first symptom of Ig AN,followed by asymptomatic physical examination and detection at the time of examination for other diseases.There was no significant difference in the initial factor between different intensity of complement C3 deposition groups.The incidence of hypertension in the strong positive group of complement C3 deposition was higher than that in the first three groups,and the main hypertension was grade 2 and grade 3.The hypertension in the group with complement C3 deposition is mainly grade 3 hypertension,and the blood pressure grade is slightly higher than that in the negative group,but there is no significant difference in the incidence of hypertension among the groups.Complement C3 deposition intensity is positively correlated with serum creatinine,urea and uric acid,and negatively correlated with e GFR.Compared with the negative group,the group with C3 deposition had higher CKD grade,but there was no significant difference between the groups.With the increase of the deposition degree of complement C3,the serum complement C3 level showed a decreasing trend,but there was no significant difference among the groups.With the increase of the deposition degree of complement C3,the 24-hour urine protein quantitative increased gradually,but there was no significant difference among the groups.There is a negative correlation between the deposition intensity of complement C3 and serum albumin.Triglycerides in the strong positive group of C3 deposition were higher than those in the first three groups,but still in the normal range,and there was no significant difference among the groups.There was no significant difference in total cholesterol,low density lipoprotein,blood glucose and hemoglobin between different levels of complement C3 deposition groups.There is a positive correlation between the deposition intensity of complement C3 and the number of urine red blood cells.4.Pathological data: In this study,the pathological Hass classification of Ig AN is mainly type Ⅲ(focal proliferative glomerulonephritis)and type Ⅳ(diffuse proliferative glomerulonephritis).With the increase of the deposition intensity of complement C3,the pathological classification level tends to be higher,but there is no significant difference in Hass classification between the groups.In Oxford pathological grade,there is a positive correlation between the intensity of complement C3 deposition and the severity of renal tubular atrophy or interstitial fibrosis.Among the three pathological types,mesangial cell hyperplasia(M1),segmental glomerulosclerosis(S1)and crescents(C1+C2),the group with complement C3 deposition is slightly more serious than the negative group,but there is no significant difference among the groups.Immune complexes were mainly deposited in mesangial area,and the positive rate of C3 deposition was 80.6%.There was a positive correlation between C3 deposition and Ig A deposition,but no obvious correlation between C3 deposition and Ig G and Ig M.ConclusionThere is no obvious correlation between the deposition intensity of complement C3 and TCM syndrome types.Complement C3 deposition intensity is positively correlated with serum creatinine,blood urea,blood uric acid and urine red blood cell count,and negatively correlated with e GFR and serum albumin.There is a positive correlation between the deposition intensity of complement C3 and the severity of renal tubular atrophy or interstitial fibrosis,Complement C3 deposition intensity is positively correlated with Ig A deposition intensity.Complement C3 deposition intensity can be used as a prognostic indicator of Ig AN.