The Study Of TCM Syndromes In Ⅳ Lupus Nephritis Accompanied With Renal Vascular Lesion And Its Relationship With Clinic And Pathology

Objective:To explore the distribution of TCM syndromes in the typeⅣlupus nephritis accompanied with renal vascular leison,and the relationship bettween TCM syndromes and its clinic and pathology.Method:Collected 153 cases of lupus nephritis patients accompanied with renal vascular leison, who were hospitalized department of nephrology in Fuzhou General HosPital of Nanjing Military Command,differentiated the TCM syndromes within three days before or after the renal biopsy,the typeⅣlupus nephritis were selected according to the results of renal biopsy,according to the standard of renal vascular leison, patients were divided into five types as follows,vascular immune complex deposits(VICD), noninflam-matory necrotizing vasculopathy(NNV),thrombotic microangiopathy(TMA),true renal vasculitis(TRV) and sclerotic vascular changes(SVC),at the the same time we collected the clinical,pathological,and SLE-DAI information,then established a database to explore the distribution of TCM syndromes in the typeⅣlupus nephritis accompanied with renal vascular leison,and the relationship bettween TCM syndromes and its clinical and Pathological.Result:1.153 cases of lupus nephritis patients were collected, including 108 cases (70.59%) of typeⅣ. There were 87 cases (80.56%) of female patients, and 21 cases (15.52%) of male patients.In typeⅣLN patients. the youngest one is 11 years old, the olddest is 71 years old, the average age was 28.11±11.26 years old. according to renal vascular pathological lesions 108 cases patients were divided into two groups, vascular disease group (58 cases,53.7%)and non-vascular disease group(50cases,46.3%). incidence of renal vascular disease in typeⅣLN patients was 53.7%,as to the glomerular filtration rate (eGFR),the minimum is 13.94ml/min,the maximum is 186.32ml/min, the mean is 55.18±37.907ml/min, according to the stages of chronic kidney disease,the numble of patients in the third stage is the largest(38.24%), the second is the second stage(26.47%),both of the two accounted for 64.71% of the total.2. There was statistically correlation between vascular lesion and the distribution of main TCM syndromes (P<0.05), the most common TCM syndromes in vascular disease group was yang defieieney of spleen and kidney, yin defieieney of liver and kidney and Hot-Poison syndrome were the second, defieieney of both qi and yin was the least(8.62%), vascularlesion correlated with blood stasis syndrome significantly (P<0.05), patients with vascular lesions combined blood stasis usually.3.There was no significant correlation between the main TCM syndromes and the pathological types of Vascular disease(P>0.05);In the distribution of blood stasis in the vascular lesions, NNV was the most common type(11cases,34.38%),followed by TMA (9cases,28.13%) and SVC(7cases,21.88%).4.There were no significant correlation between the main TCM syndromes and hypertension,gross hematuria(P>0.05). blood stasis syndrome correlated with renal insufficiency significantly(P<0.05),and patients with blood stasis syndrome were in a high incidence of renal dysfunction (62.5%). blood stasis syndrome did not correlate with hypertension and gross hematuria (P> 0.05).5.There was statistically difference in the CI (chronic index) and SLE-DAI among the main TCM syndromes(P>0.05),but there was no statistical difference in the AI(activity index); The difference between TCM Syndromes and the staging of disease activity in SLE-DAI was statistically significant(P<0.05).The differences betweeen blood stasis syndrome and non-blood stasis syndrome group in CI, SLE-DAI were significant (P<0.05), but there was no significant difference in AI(P>0.05).6.The relationship in fibrinogen, plasma D dimer, anti-cardiolipin antibodies among different main TCM syndromes were not significant(P>0.05);The difference between blood stasis syndrome and non-blood stasis syndrome group in D-dimer was significant(P>0.05), The value of plasma D-dimer in patients with blood stasis syndrome is higher than that in patients who do not combined blood stasis.Conclusion:1.Renal Vascular lesion in type IV lupus nephritis correlated with the distribution of main TCM syndromes, vascular lesions correlated with blood stasis syndrome, vascular lesions correlated with blood stasis syndrome.2.There is no correlation between main TCM syndromes and the pathological types of vascular disease, There is significient correlation between blood stasis syndrome and the pathological types of vascular lesion.3.Blood stasis syndrome correlated with renal insufficiency.4.TCM Syndromes correlated with the disease activity of LN patients,the type IV LN Patients accompanied with renal vascular lesions were usually in the active stage, and with moderate to severe active stage-based.5. Blood stasis syndrome correlated with plasma D dimer.