| ObjectiveTo analyze the TCM syndromes and clinicopathological features of IgA nephropathy with different degrees of tubulointerstitial lesions,and to explore the related risk factors of renal tubulointerstitial lesions in IgA nephropathy.Methods(1)Select 452 patients with IgA nephropathy who have complete clinical and TCM syndrome data from the kidney disease database of Guangdong Provincial Hospital of Traditional Chinese Medicine and who have been diagnosed as having renal biopsy.(2)We used Ka's semi-quantitative integration to score 452 IgA patients.According to the scores of renal tubulointerstitial disease,there were no tubulointerstitial lesions(T0 group)and mild tubulointerstitial lesions(T1 group).,moderate tubular interstitial lesions(T2 group)and severe tubulointerstitial lesions(T3 group).(3)Analysis of clinical,pathological and TCM syndromes in patients with IgA nephropathy showed differences in different renal tubulointerstitial lesions;Logistic regression was used to screen independent risk factors affecting tubulointerstitial lesions.ResultsOf the 452 patients with IgA nephropathy,214 were males and 238 were females(male ratio: 0.89:1).The average age was 33.52±11.58 years.Using Ka's semi-quantitative integration,44 cases were divided into T0 group,260 cases in T1 group,89 cases in T2 group,and 59 cases in T3 group.1.General information(1)There was no significant difference in gender between different degrees of renal tubulointerstitial lesions(P >0.05).(2)There was significant difference in the age of onset between different degrees of renal tubulointerstitial lesions(P <0.05).The comparison between the onset age groups showed T3> T2> T1> T0(P <0.05).2.Clinical data(1)There were significant differences in serum creatinine,eGFR,hemoglobin,urinary protein,and blood urea nitrogen in different degrees of tubulointerstitial lesions(P <0.05).Serum creatinine,urinary protein quantification,and blood urea nitrogen were the two groups.T3 group>T2 group>T1 group>T0 group(P <0.05).Comparison between eGFR and hemoglobin groups showed T0>T1>T2>T3(P <0.05).(2)Serum uric acid,total cholesterol,and triglyceride levels in the T3 and T2 groups were significantly higher than those in the T0 and T1 groups(P <0.05);there was no difference between T3 and T2,T1,and T0(P <0.05),but there is a gradual upward trend.Serum albumin was significantly lower in the T3 group than in the T0,T1,and T2 groups(P <0.05).Hematuria,complement C3,complement C4,serum IgA,IgG,high-density lipoprotein,and low-density lipoprotein were not significantly different in different renal tubulointerstitial lesions(P >0.05).(3)In the Hass3 classification,the T0 group was dominated by grades I and II,which was higher than the other three groups.The difference was statistically significant(P <0.05).T1 and T2 groups were mainly grade III,which was higher than the other two groups.The difference was statistically significant(P <0.05).Among them,the proportion of IV-V in T2 group was higher than that in T1 group(P < 0.05);T3 group mainly IV-V grade,the proportion was higher than the other three groups,the difference was statistically significant(P <0.05).(4)Oxygen classification showed that segmental sclerosis or adhesion(S)and tubule atrophy/interstitial fibrosis(T)were statistically significant between the two groups(P <0.05);endothelial cell proliferation(M)was T0,T1 and T2,T3 group differences(P <0.05);Crescent(C),the highest proportion of C0 in each group,T0 group> T1 group> T2 group> T3 group(P < 0.05);C1 in the T1,T2,T3 group than the T0 group(P <0.05);C2 in the proportion of each group: T3 group> T2 group> T1 group> T0 group(P <0.05).In renal vascular disease,the incidence of renal vascular lesions was significantly higher in the T2 and T3 groups than in the T0 and T1 groups(P <0.05).(5)Ordered multi-classified Logistic regression analysis showed that age,serum creatinine,eGFR,serum albumin blood,hypertension,renal angiopathy,and crescent regression analysis were statistically significant(P <0.05).3.TCM syndrome type(1)In the case of deficiency,the proportion of patients with qi and yin deficiency in T0 and T1 groups was higher than that in T2 and T3 groups.The proportion of patients with spleen and kidney yang deficiency in T2 and T3 groups was higher than that in T0 and T1 groups(P <0.05),but in lungs.There was no statistical difference between the groups with deficiency of spleen qi and deficiency of liver-kidney yin deficiency(P >0.05).(2)In terms of the empirical evidence,the proportion of patients with blood stasis in the T2 and T3 groups was higher than that in the T0 and T1 groups(P <0.05).There was no statistical difference between dampness heat syndrome and cold dampness syndrome(P >0.05).(3)There is no significant difference in TIL scores among patients with IgA nephropathy with TCM syndrome type(P >0.05).On the basis of empirical evidence,the score of renal tubulointerstitial lesions in IgAN patients with blood stasis syndrome is higher(P <0.05).Cunclusions(1)IgA nephropathy has a high incidence of renal tubulointerstitial injury.The heavier the clinical manifestations(creatinine,eGFR,hemoglobin,urinary protein and blood urea nitrogen),the higher the Hass grade,the higher the segmental sclerosis/adhesion and the proportion of crescents.It often suggests that the degree of renal tubulointerstitial damage is heavier.(2)Older age,elevated serum creatinine,decreased eGFR,decreased serum albumin,hypertension,renal vascular disease,and crescents are independent risk factors for aggravation of renal tubulointerstitial lesions in IgA nephropathy.(3)TCM Syndrome Differentiation This deficiency is mainly caused by deficiency of both qi and yin.The spleen-kidney yang deficiency syndrome is more prominent in patients with hepatic tubulointerstitial lesions.The benchmark evidence is mainly damp-heat syndrome,and the renal tubular interstitial lesions are most serious in patients with blood stasis syndrome. |
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