The Study Of Risk Factors And TCM Syndromes For Tubulointerstitial Lesions In Lupus Nephritis

ObjectiveLupus nephritis?LN?is the most common and serious complication of systemic lupus erythematosus?SLE?,Tubulointerstitial lesions?TIL?not only have a high incidence in LN,but also have a profound effect on treatment and prognosis.Analyze the relationship between TIL and clinical,pathological parameters and TCM syndrome types.Independent and important risk factors of the TIL were screened.MethodA retrospective analysis of 145 LN patients undergoing concurrent renal biopsy in our hospital was performed to obtain general data,clinical,laboratory examinations,and pathological data.TIL?including interstitial cell infiltration,degeneration of tubular epithelial cells,tubular atrophy,a n d i nt er s ti ti a l f i br o si s?wa s s emi-qu a nt it a ti ve l y s c or e d.T h e characteristics of different pathological types of TIL were compared.The correlation between TIL and clinical and pathological parameters was analyzed by rank correlation analysis and its correlation with LN syndrome differentiation.Independent risk factors affecting TIL were screened by multivariate logistic regression analysis.Results1.145 patients with LN were included,male/female was 19:126;the average age of renal biopsy was 30.4±13.16 years?11-70?,and the incidence of TIL was 91.1%.2.Distribution of pathological types of LN in the enrolled patients:0in type I?0.0%?,5 in type II?3.4%?,25 in type III?17.2%?,58 in type IV?40.0%?,and 16 in type V.?11.1%?,0 cases?0.0%?.There were 17 cases?11.7%?of type III+V and 24 cases?16.6%?of type IV+V.Among the different pathological types of LN,the degree of tubulointerstitial lesions of type IV,III+V,and IV+V was the most severe.There was no statistical difference between the above three pathological types?P>0.05?.Type IV was more than type III intertubular tubules.The mass lesions were heavier and the difference was statistically significant?P<0.05?.Type II and type V renal tubular interstitial lesions were mild.3.In this group of patients,the difference of hypertension classification and CKD staging in different TIL distributions was statistically significant?P<0.05?.With the increase of blood pressure,the degree of TIL was aggravated.With the decrease of renal function,the incidence of renal tubulointerstitial lesions increased.Its degree has also increased.There was no significant difference in gender,age,and urinary protein among different TILs?P>0.05?.4.Analysis of interstitial cell infiltration,renal tubular epithelial cell degeneration,renal tubular atrophy,interstitial fibrosis and clinical and pathological data were correlated with blood pressure,?₂ microglobulin,complement C4,cellular crescents There was a positive correlation between spheroid,sclerosis,fibrous crescent,thickening of vascular endothelium and hyaline degeneration?P<0.05?,and negative correlation with hemoglobin and eGFR?P<0.05?.5.In pathological parameters,spherosclerosis,fibrous crescent,and vascular endothelial thickening were independent risk factors affecting the severity of LN-interstitial pathological changes;in clinical indicators,eGFR decreased,anemia,hypertriglyceridemia,Low complement C3 is an independent risk factor that influences the severity of LN interstitial lesions.6.This card includes 32 cases?22.07%?of Qi and Yin deficiency,16 cases?11.03%?of heat-toxic flaming syndrome,18 cases of rheumatism?12.41%?,50cases of spleen and kidney qi deficiency?34.48%?,spleen and kidney.There were 18 cases of Yang deficiency?12.41%?and 11 cases?7.59%?of liver-kidney yin deficiency syndrome.The syndrome included 90 cases of blood stasis syndrome?62.07%?and 51 cases of damp-heat syndrome?35.17%?.There was no statistically significant difference in the distribution of TCM syndromes among the pathological types of LN?P>0.05?.There was no significant difference in the TIL scores between the two syndromes?P>0.05?.ConclusionThe prevalence of TIL is high in lupus nephritis,and the degree of T IL is increased when hypertension and renal function decline.Pathologica l type IV,III+V,IV+V renal tubulointerstitial lesions are more impo rtant than patients with type III,II and V type.Globular sclerosis,fib rous crescent,thickening of vascular endothelium,decreased eGFR,anemia,hypertriglyceridemia,and low complement C3 were independent risk factor s affecting tubulointerstitial lesions.There was no significant differen ce in the degree of TIL between TCM symptoms.