Correlation Between TCM Syndrome And Clinicopathology Of BMI And IgA Nephropathy

BackgroundIgA nephropathy is currently one of the most common primary glomerular diseases in the world, clinical to see more young men. It’s often characterized by recurrent episodes of naked eye hematuria or microscopic haematuria, asymptomatic proteinuria. It also may be accompanied by edema and hypertension. Its pathogenesis is not fully clearly, the treatment is given priority to with RAS blockade, hormone and immune inhibitor treatment. IgA nephropathy of factors of risk includes 24-hour proteinuria quantitative prognosis, high blood pressure, injuring renal function. Possible factors include uric acid, blood in urine, etc. BMI affects the prognosis of IgA nephropathy is relatively small, in the domestic reports and BMI as one of the possible prognostic factors about influencing the IgA nephropathy, pathological damage to kidney, but it has rare reports in China. So this topic is to explore the BMI with IgA nephropathy clinical indicators, pathology, such as correlation, rich in the early diagnosis of IgA nephropathy, expected to guide the prognosis and treatment of IgA nephropathy.PurposePreliminary discusses on the body mass index (BMI) with IgA nephropathy syndrome of traditional Chinese medicine,clinical indexes and renal pathologic correlation.MethodsCollecting from January 2011 to October 2011 in China academy of traditional Chinese medicine hospital gate line renal biopsy diagnosis of primary,206 cases of patients with IgA nephropathy, according to the BMI criteria into a higher BMI was 134 cases,72 cases of normal BMI. TCM syndrome between two groups were retrospectively analyzed, clinical indicators (eGFR, Cr, BUN, high blood pressure, UA,24 hours urinary protein, HGB, propagated, etc.), the differences between the kidney pathological type (Oxford).The results1 General information(1) Gender:A high BMI is set for 80 cases of male and female for 54 cases, male to female ratio is 1.48:1. For 31 cases of normal BMI group of men, women in 41 cases, male to female ratio is 0.76:1. Statistical differences between two groups (P=0.02). (2) Age:high BMI group of average age is 40.16±12.42 years of age, young people have 88 cases, accounting for 65.67%.Middle-aged people have 35 cases,accounting for 26.12%.The elderly of 11 cases, accounting for 8.21%.High BMI IgA nephropathy patients are more common in men.2 the correlation between BMI and IgA nephropathy TCM syndrome2.1 deficiency syndromeHigh BMI distribution group for deficiency of both vital energy and yin have 40 cases (29.85%), spontaneous sweating with syndrome of qi deficiency of lung and spleen have 20 cases (14.93%), liver and kidney "Yin deficiency have 11 cases (8.21%), spleen and kidney Yang deficiency has 1 case (0.75%). Normal distribution of BMI group of qi and Yin deficiency have 33 patients (45.83%),9 cases of liver and kidney Yin deficiency (12.5%), lung temper have 7 cases (9.72%), spleen and kidney Yang deficiency has 1 case (1.39%). Between the two groups of qi and Yin deficiency syndrome is statistical difference (P= 0.02). Patients with a higher BMI is qi and Yin deficiency syndrome.Tallies deficiency syndrome no statistical difference between two groups.2.2 EmpiricalIn patients with higher BMI group, phlegmy wet have 82 cases, accounting for 39.81%. Hot and humid have 63 cases, accounting for 30.58%.25 cases of blood stasis,accounting for 12.14%. Turbidity toxin have 17 cases,accounting for 8.25%.Wet have 10 cases, accounting for 4.85%.Cold dampness have 6 cases (2.91%), liver depression have 3 cases, accounting for 1.46%. In patients with normal BMI, blood stasis,26 cases (36.11%). Phlegmy wet have 17 cases, accounting for 23.61%. Hot and humid have 12 cases,accounting for 16.67%.Turbidity toxin in 11 cases,accounting for 8.25%.Liver depression (3 cases), accounting for 4.17%, and dampness in 2 cases, accounted for 2.78%, water wet in 1 case, accounting for 1.39%. Between the two groups with phlegm dampness, damp and hot, blood stasis was statistically difference (phlegmy wet P= 0.00, hot and humid P= 0.00, P= 0.00) blood stasis.More than standard empirical no statistical difference between two groups.High BMI group of damp heat and phlegm dampness syndromes.3 the correlation between BMI and clinical indicators3.1 BMI independent risk factors and prognosis of IgA nephropathyRenal function:(1) high BMI group of eGFR is 76.99±30.31 ml/min (1.73m2), Cr median 89.00 umol/L, BUN median tendency for 5.93 mmol/L. Normal BMI group of eGFR is 81.47±32.85 ml/min (1.73 m2), Cr median 80.00 umol/L, BUN median tendency for 5.53 mmol/L. Between the two groups in eGFR, CR, BUN, no statistical difference (P= 0.33 of eGFR, CR of P= 0.17, BUN of P= 0.24). (2)High blood pressure, high BMI group of patients with high blood pressure level 2 of 31 cases (23.13%),3rd level 45 cases (33.58%). Normal BMI group of high blood pressure level 2 of 6 cases (18.66%),3 grade 11 cases (28.36%). Statistically difference between two groups (P= 0.00), high BMI group of high blood pressure level 2, level 3.(3) 24 hours urinary protein:a higher BMI is set a median of 1.69 g/d, normal BMI group of a median of 1.59 g/d, no statistical difference between two groups (P= 0.18). (4)UA:high BMI group of high uric acid in 70 patients (76.70%), normal BMI group of 21 patients with high uric acid (23.30%), the difference between the two groups (P= 0.00), high BMI group of high uric acid hematic disease. High BMI group of uric acid in the median of 402.00umol/L, normal BMI uric acid median 328.50umol/L. Statistical differences between two groups (P= 0.00).High BMI group of uric acid value.3.2 BMI and other clinical indicators(1)The hemoglobin HBG high BMI group is 138.42±18.74 g/L, normal BMI group HGB is 132.70±23.10 g/L, no statistical difference between two groups.(2)blood biochemical: propagated high BMI group was 38.09±6.21 g/L, TG median tendency for 2.12mmol/L, HDL median tendency for 1.12 mmol/L, LDL median tendency for 3.01 mmol/L. CHO median tendency for 4.98 mmol/L. Normal BMI propagated is 34.93±8.48 g/L, TG median tendency for 1.48 mmol/L, HDL median tendency for 1.30 mmol/L, LDL median tendency for 2.82 mmol/L, CHO median tendency for 4.95 mmol/L. TG and HDL is statistically difference between two groups (P< 0.05), propagated, CHO and LDL no statistical difference (P> 0.05 of propagated,CHO,P=0.88, LDL(P=0.13), high BMI group, TG and HDL. Immunoglobulin A (3) High BMI group of IgA is 2.96±1.16 mg/mL, normal BMI IgA is 2.87±1.02 mg/mL. IgA is no statistical difference between two groups (P> 0.05).3.3 BMI correlated with stage of chronic kidney disease (CKD)High BMI groups,CKDl period for 42 cases, accounting for 31.34%.CKD2 period for 52 cases, accounting for 38.81%.CKD3 period for 33 cases, accounting for 24.63%.CKD4 period for 5 cases, accounting for 3.73%.CKD5 period for 2 cases, accounting for 1.49%.Normal BMI groups, CKD1 period for 26 cases, accounting for 36.11%.CKD2 period of 29 cases, accounting for 40.28%.CKD3 period for 12 cases, accounting for 16.66%.CKD4 period for 4 cases, accounting for 5.56%.CKD5 period for 1 case, accounting for 1.39%. No statistical difference between two groups (P> 0.05).4 BMI and IgA nephropathy pathologic correlationHigh BMI group of focal hyperplasia of type 88 (65.67%), mild mesangial proliferation type 25 cases (18.65%), focal hyperplasia of necrosis type 16 cases (11.94%), crescent shape in 4 cases (2.99%), capillary hyperplasia in 1 case (0.75%), hyperplasia sclerosis type 0 (0%). Normal BMI focal hyperplasia of 47 cases (65.28%), mild mesangial proliferation type 15 cases (20.83%), focal hyperplasia of necrosis type 7 cases (9.72%), hyperplasia sclerosis type 2 (2.78%), capillary hyperplasia in 1 case (1.39%), crescent shape 0 cases (0%). No statistical difference between two groups (P> O.05).High BMI groupof 110 cases (82.09%), M1 E1+ E2 for 23 cases (11.17%), SI for 68 cases (33.01%), T1+T2 for 96 cases (71.64%).Normal BMI group of 65 cases (90.28%), M1 E1+E2 for 18 cases (8.74%), S1 for 18 cases (8.74%), T1+T2 for 57 cases (79.17%). Between the two groups with Oxford classification M, E, S, T no statistical difference between (P= 0.12 M1, El+E2, P= 0.18, S1 P= 0.57, T1+T2 P= 0.24).Conclusion1. High BMI IgA nephropathy patients are more common in men.2. Patients with a higher BMI is deficiency of both vital energy and yin, the empirical damp heat and phlegm wet.(3) Common in patients with a higher BMI is associated with high blood pressure, high uric acid hematic disease and hyperlipidemia.4. No differences between BMI and renal pathology.