| BackroundMembranous nephropathy(MN)is a group of diseases characterized by diffuse thickening of the glomerular basement membrane(GBM)epithelial cells,which is characterized by idiopathic membranous nephropathy IMN),is one of the common pathological types of adult nephrotic syndrome.The cause of IMN is not clear,the pathogenesis is complex,the prognosis have a large individual differences.At present,about 1/3 of IMN patients can spontaneously relieve,1/3 of IMN patients have a fluctuation in proteinuria,and the other patients progress to end stage renal disease(End Stage Renal Disease,ESRD)or died of related complications.Related literature records of the typical pathological changes of membranous nephropathy mainly in the glomerular basement membrane,rarely involving the mesangial area,but the clinical IMN patients with mesangial cell proliferation were a few,the clinical manifestations of the type of patients,Pathologic features and prognostic characteristics of the relevant research is still unclear.Although the Chinese medicine on the understanding of the disease is more perfect,according to its clinical large number of proteinuria,edema characteristics,will be classified as "urine" "edema",but the relationship between the pathologic features of cell proliferation and TCM syndromes is still lacking.Therefore,this study intends to explore the relationship between mesangial cell proliferation and TCM syndrome,clinical and pathological characteristics.ObjectiveTo explore TCM syndrome,clinico-pathological characteristics and prognosis of idiopathic nephropathy(IMN)with mesangial cell proliferation.Methods261 cases were all from Guang'an men Hospital.Clinico-pathological characteristics and the prognosis of IMN without mesangial cell proliferation were reviewed.Eligible patients were divided into two groups according to the proliferated mesangial cells,and their data were compared.The related factors of prognosis of IMN were analyzed by binary logistic regression.Results1.TCM symptoms distribution Common symptoms associated with mesangial cell proliferation group are edema(121cases,87.1%),foam(120cases,86.3%),fatigue(95cases,68.3%),waist discomfort(90cases,64.7%),abdominal distension(60cases,43.1%),insomnia(58cases,41.7%),flustered shortness of breath(55cases,39.5%);Common symptoms associated with non-mesangial cell proliferation group are fatigue(90cases,73.7%),edema(89cases,72.9%),waist discomfort(76cases,62.3%),foam urine(48cases,39.3%),flustered shortness of breath(42cases,34.4%),insomnia(40cases,32.7%),abdominal distension(38cases,31.1%).The rate of Edema and bubble urine in mesangial proliferation group showed higher than that in non-mesangial proliferation group(P<0.05).2.The type of TCM syndromeThe main type of syndrome in the two groups is Qi and Yin Deficiency,blood stasis.And the rate of the spleen and kidney qi(yang)deficiency in mesangial proliferation group was higher than that in non-mesangial proliferation group(P<0.05).3.Basic materialsGender:There are 67 males(48.2%)and 72 females(51.8%)in mesangial proliferation group.Comparison of gender showed that the proportion of women with mesangial cell proliferation was higher than that without mesangial cell hyperplasia(P<0.05).Course of the disease:The duration of mesangial cell proliferation group and non-mesangial proliferation group is 5.0(2.0,12.0)vs 4.0(2.0,8.0)months.There was no statistical significances between course of the disease(P>0.05).Age:The age of renal biopsy of mesangial cell proliferation group and non-mesangial proliferation group is 49.28 ± 13.38vs51.54 ± 13.48 years old.There was no statistical significances between course of the disease(P>0.05).4.Clinical situation4.1 Accompanying diseases and complicationThere were no significant differences in hypertension,dyslipidemia,hyperuricemia,type2 diabetes mellitus,coronary heart disease,atherosclerosis and cerebrovascular disease between two groups(P>0.05).4.2 Laboratory indicatorsPlasma Albumin(Alb):The Al±b of mesangial cell proliferation group and non-mesangial proliferation group is 25.93±6.88vs24.32±6.33g/L,There was no statistical significances between the two groups(P>0.05).The serum creatinine(Scr):The Scr of mesangial cell proliferation group and non-mesangial proliferation group is 67(55,80)vs70(63,83)umol/L,There was significant difference between the two groups(P<0.05).Blood lipids:The level of plasma triglyceride(TG)in mesangial cell proliferation group and non-mesangial proliferation group is 2.1(1.52,3.04)vs2.4(1.65,3.43)mmol/L5 The level of plasma cholesterol(CHO)is 7.0(5.76,8.29)vs7.7(6.54,9.57)mmol/L,The level of plasma low density lipoprotein(LDL)is 4.25 ± 1.43vs4.86 ± 1.61 mmol/L.The level of CHO and blood LDL in the mesangial cell proliferation group was lower than that in the non-synovial cell hyperplasia group(P<0.05).24 hours urine protein(24h-UTP):The 24h-UTP of mesangial cell proliferation group and non-mesangial proliferation group is 3008(1904,4590)vs3179(2522,4914)mg/24h,There was no statistical significances between the two groups(P>0.05).Urine test erythrocyte count>3/HP:The rate of urine test erythrocyte count ?3/HP with mesangial cell proliferation and non-syncytial cell proliferation group was 54.7%vs 45.9%,There was no statistical significances between the two groups(P>0.05).Estimation of glomerular filtration rate(eGFR):The eGFR of mesangial cell proliferation group and non-mesangial proliferation group is 104(88.35,120.95)vs96(75.59,116.67)ml/min/1.73m2,There was significant difference between the two groups(P<0.05).5.Pathological featuresRenal pathology stage:The pathological stage of mesangial cell proliferation group and non-mesangial proliferation group is located in stage I and II.The rate of stage ?,stage ?-?,stage ?,stage ?-? and stage ? in the two groups is 42.4%vs48.4%,21.6%vs14.8%,26.6%vs27.9%,8.6%vs8.2%and 0.7%vs0.8%,And there were no significant difference between the two groups(P>0.05).Glomerular lesions:There are 8 cases(5.7%)with segmental sclerosis in mesangial cell proliferative group,50 cases(36%)in sclerotic sclerosis,14 cases(10.2%)in crescent cells,Compared with non-mesangial proliferation group,there was no significant difference(P>0.05).Renal tubular lesion:The two groups are all seen tubular epithelial vacuoles and pelvic degeneration.102 cases(73.4%)are seen focal atrophy in mesangial cell proliferative group.There was no significant difference between the two groups(P>0.05).Renal interstitial lesions:There are 4 cases(2.9%)with renal interstitial edema in mesangial cell proliferative group,98 cases(70.5%)of renal interstitial inflammatory cell infiltration,103 cases(74.1%)of interstitial fibrosis,There was no significant difference between the two groups(P>0.05).Renal vascular lesions:There are 119 cases(85.6%)with small arteriosclerosis in the mesangial cell hyperplasia group,and there was no significant difference between the two groups(P>0.05).Renal tissue immunofluorescence:In addition to IgG and complement C3 deposition,there are also can be seen with low-intensity IgA,IgM deposition in mesangial cell proliferative group.6.Prognosis3 years of remission rate:The 3 years of remission rate of mesangial cell proliferation group and non-mesangial proliferation group is 59.6%vs 42.3%.There was significant difference between the two groups(P<0.05).Kidney cumulative survival rate:Kaplan-Meier method was used to evaluate the cumulative survival rate of the two groups,and there was no significant difference between the two groups(x2 = 1.248,P = 0.264).Kidney cumulative remission rate:Kaplan-Meier method was used to evaluate the complete remission of the two groups for the first time.The cumulative remission rate between the two groups was not statistically significant(x2 = 1.965,P = 0.161).The risk factors of renal remission:Age>50 years old is an independent risk factor affecting IMN clinical remission.The application of immunosuppressive agents is a favorable factor for renal remission.There is no significant correlation between mesangial cell proliferation and IMN prognosis.ConclusionThe common TCM symptoms and the type of TCM syndrome in mesangial cell proliferation group are edema,bubble urine and Qi and Yin Deficiency,blood stasis.The incidence of mesangial cell proliferation was higher in females,and its renal damage was lighter.In addition to IgG and complement C3 deposition,there were also can be seen with low-intensity IgA,IgM deposition in mesangial cell proliferative group.There is no significant correlation between mesangial cell proliferation and IMN prognosis. |
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