Study On Syndrome Of IgA Nephropathy With Different Risk

Background:IgA nephropathy (IgAN) is the most common type of primary glomerulopathy characterized by IgA complex deposition on glomerular mesangium.35～40% patients were diagnosed with IgAN among all patients who had primary glomerulopathy in China by means of renal biopsy. About 1/3 of patients with IgAN will progress to end stage renal disease in 10 to 20 years. Proteinuria, hypertension and renal insufficiency (or evidence of sclerosis on histology) is the most important factor in prognosis evaluation. Experts recommend IgAN should be treated by stages. Comprehensive treatment is the core of IgAN grading treatment.Traditional Chinese medicine(TCM) has certain advantages in reducing the acute attacks of IgAN, reducing proteinuria and delaying the progress of renal function. The latest IgAN TCM syndrome differentiation standards have been released, but how to play it in IgAN grading treatment need our further discussion.Objective: To explore the distribution of TCM syndromes in different risk stratification of patients with IgAN,so as to provide basis for the IgAN grading treatment of TCM.Methods:To survey the patients meeting the inclusion and exclusion criteria with IgAN diagnosed by renal biopsy in Guang’anmen Hospital, China Academy of Chinese Medical Sciences from May 2013 to March 2015.Using the latest IgAN syndrome differentiation guide as a reference and making a syndrome differentiation for patients in the group to explore the characteristics of TCM syndrome distribution of different risk stratification of patients with IgAN.Results:1 General information1.199 Patients with IgAN diagnosed by renal biopsy in Renal Department of Guang’anmen Hospital, China Academy of Chinese Medical Sciences from May 2013 to March 2015. According to the exclusion criteria,3 cases of allergic purpura nephritis were excluded. The study included 96 patients with IgAN. There were 53 males (55.2%) and 43 females (44.8%), male to female ratio was 1.23:1. The average age of these patients was 40.2±11.84y.The eldest one was 71 y and the youngest one was 21y. Men with an average age of 40.17±12.36 y and women with an average age of 40.23±11.25 y (P>0.05).1.2 There were 22 (22.9%) people in the low risk group,60 (62.5%) people in the medium risk group and 14 (14.6%) people in the high risk group among the 96 patients in the study.2. Clinical data2.1 The mean blood pressure of the 96 patients was 132.18±15.112/83.3±12.36 mmHg. 27 patients had hypertension in the medium risk group (45.8% of the medium risk group),7 patients had hypertension in the high risk group (50% of the high risk group). There was no difference between the high risk and the medium risk groups on blood pressure (P>0.05).2.2 The quantitative test of 24h urinary protein for the 96 patients showed an average data of 2.04±1.79g.There were differences between different risk level groups on urinary protein in 24 hours(P<0.01).2.3 The mean eGFR of the 96 patients was 74.12±31.33ml/min/1.73m2.The lowest eGFR in the high risk group was 50.38±30.99 ml/min/1.73m2 while the highest eGFR in the low risk group was 95.96±29.59 ml/min/1.73m2.There were differences between the two groups on eGFR(P<0.017)2.4 When it came to the period of IgAN of the 96 patients, most 1 period patients were in the low risk group. Patients in the medium risk group mainly distributed in 1～3 period while 2 period patients were in the majority. The amount of 4-5 period patients increased in the high risk group.3. Pathological data3.170.8%patients had renal tubular atrophy and interstitial fibrosis in the 96 cases. Half of them had renal tubulointerstitial lesions in the range of 25～50%.3.2 All pathological index ratio increased with the increasing of risk level but we don’t think they were related for the Spearman correlation coefficient test. (P<.05)4. Symptoms of TCM4.1 The top 10 symptoms appeared in the 96 patients were lassitude (51.3%),soreness and weakness in lower back and knees (50.2%),mouth dryness (48.3%),foam in urine (42.7%), dizziness (36.5%),oedema legs (33.3%),intolerance of cold (24%),insomnia (22.9%), spontaneous sweating (22.9%) and pallor (21.9%).The tongue texture was mainly red (37.5%)or dark (36.5%).The tongue coating was mainly thin&white (29.5%)or greasy & yellow (27.5%).The pulse was mainly thready&rapid (22.9%)or slippery&rapid (12.5%).4.2 The syndromes of the 96 patients were as follows:9 had exogenous wind-heat (9.4%),5 had damp-heat in lower-jiao (5.2%),12 had qi insufficiency of the lung and spleen (12.5%),29 had insufficiency of both qi and yin(30.2%),22 had yin deficiency of liver and kidney (22.9%),19 had yang deficiency of both the spleen and kidney (19.8%).5. Main TCM syndromes of patients with IgAN distributed in different risk stratification.5.1 There was no significant difference between acute and chronic groups on risk stratification (P=0.586>0.05).5.2 There were differences on the distribution of TCM syndromes between groups had different risk during the chronic-phase (P<0.05).As risk level increasing the rate of qi insufficiency of the lung and spleen syndrome decreased (P<0.05) and yang deficiency of both the spleen and kidney syndrome increased (P<0.05).6. Accompanying symptoms of patients with IgAN distributed in different risk stratification.6.1 It was significant that the number of accompanying symptoms varied between different risk groups. There was usually only 1 type of accompanying symptom in the low risk group while the most common one was the damp-heat (36.4%).The high risk group often associated with 3 types of accompanying symptoms while the most common combination was the damp-heat&blood stasis& turbid toxin (35.7%).The distribution of accompanying symptoms in the medium group was average (P<0.05).6.2 The accompanying symptoms appeared most frequently in the 22 patients of the low risk group were the damp-heat (50%),the blood stasis (45%)and the phlegm-damp (27.3%).The most common accompanying symptoms of the 60 patients in the medium risk group were the blood stasis(55%),the turbid toxin(38.3%)and the damp-heat (36.7%).The main types of accompanying symptoms in the high risk group were the turbid toxin (71.4%),the blood stasis (57.1%)and the damp-heat (50%).The damp-heat and the blood stasis had accounted for a great proportion in each groups of the risk stratification. The relationship between the turbid toxin and the risk level was that the turbid toxin increased with the increasing of risk level (P<0.05). Conclusion:1.There was a close relationship between clinical risk stratification and the treatment & prognosis of IgAN but the relationship between clinical risk classification and renal pathological was not obvious.2. Risk classification was related to TCM syndrome in patients with IgAN. Along with the increase of risk level, qi insufficiency of the lung and spleen syndrome decreased and yang deficiency of both the spleen and kidney syndrome increased gradually. Accompanying symptoms and the ratio of turbid toxin syndrome gradually increased at the same time.