Clinical Features And Traditional Chinese Medicine Syndromes Of Immunoglobulin A Nephropathy

ObjectiveTo investigate the general characteristics,clinical and pathological features,and the distribution of TCM syndromes in patients with IgA nephropathy in Guangdong,and to explore the correlati on between the level of proteinuria of IgA nephropathy and clinical indexes,Pathological features and TCM syndromes.To provide at heoretieal basis for the traditional Chinese medieine in the treatment of different level of proteinuria of IgA nephropathy,and to provide a theoretical basis for the rational diagnosis and treatment of IgA nephropathy and to judge the prognosis of the disease.Methods365 cases of IgAN aggregately definited by renal biopsy in ward of Kidney Center of Guangdong llospital of TCM from January 2011 to December 2018 were collected.Thc patients' complete history,TCM syndromes,treatment g eneral situation,clinical and pathological data were retrospectively studied,and the statistics were analyzed by SPSS22.0 software.According to sex,age,hyperlipidaemia,hyperlipidaemia,hyperuricemia,proteinurlia,hypertension,nephrotic syndrome and renal function level were grouped compare their clinical,pathological characteristics and the correlation of TCM syndrome type.Results1.Of the 365 patients with IgAN,the sex ratio was 0.97:1.The average age was 35.08±11.02 years old.The course of the disease was 0.1±24 Omonths.The 24 hour urinary protc-in quantity was 1.75±2.07g,Among them,184 cases(50.4%),134 cases(:36.7%),and 47 cases(12.9%)of patients with urinary protoin less than or equal to lg/d,1~3.5g/d,and>3.5g/d,respectively;and serum albumin 38.74±6.49g/L.N ephrotie syndrome were 25(6.8%).Hematuria were 336 cases(92.1%).There were 133 cases with hyper tension(36.4%)and 213 cases with hyperuricemia(58.4%).The eGFR<60 ml/(min·1.73m2)were involved in 111 cases(30.4%).2.The Oxford classification of 365 IgA nephropathy patients was shown in figure 2,which was divided into 15 types and distributed as follows:M1E1S1T2(12 cases),M1EOS1T2(27 cases),MIF ISOT2(3 cases),M1EOSOT2(10 cases),M1E1S1T1(5 cases),M1E1SOTI(5 cases),MIF1SOT1(19 cases),M1E 1S1T0(18 cases),M1EOS1T((7 cases),MOEOSOTO(4 cases),MOEOS1TO(6 cases),MOEOSOTO(21cases).3.Compared with the female group,the clinical symptoms of the male group were as follows:Incidence of renal insufficiency,systolic blood prossure,diastolic pressure,serum albumin,serum creatinine,serum trioxyp urine,hemogloh in level were higlier in the male group than in the female group(P<0.05).4.The morbidity of hyperlipidemia,renal insufficiency and the incidenee of tubular atrophy/interstitial fibrosis in the middle-age group was higher than that in the youth group.The level of systolic blood pressure,urea nitrogen,triglyceride in middle-aged group was higher than that in young group;The level of serum albumin,hematocrystallin and eGFR levels in middle-aged group and the elderly group was lower than that in youth group.5.The morbidity of hypertension,hyperlipidemia and renal dysfuncti.on of IgAN sufferer with hyperuricemia is higher than that of IgAN sufferer with normal uric acid level,the same as the male proportion,systolic blood pressure,age,diastolic pressure,24-hour urinary protein quantity,creatinine,urea nitrogen and triacylglycerol level,while eGF-R level is relatively low,the morbidity of tubular atrophy/interstitial fibrosis of IgAN patients with hyperuricemia is more than that of IgAN sufferer with normal uric acid level(P<0.05).6.The morbidity of renal insufficiency and serum uricacid levelof IgAN patients with moderate-severe urinary protein is higher than that of IgAN patients with mild urinary protc in,The difference is statistically signiificant(P<0.05).With urinary protein,the incidence of hypeltension,hyperlipemia,systolic blood pressure,diastolic pressure,gerum creatinine,urea nitrogen,cholesterin,triacylglycerol increased,while serum albumin,hemoglobin,and eGFR levels declined(P<0.05).7.The morbidity of segmental glomerulosclerosis of IgAN patients with moderate urinary protein is higher than that of IgAN patients with mild urinary protein,The difference is statistically significant(P<0.01);with urinary protein,thc,Incidence of endocapillary proliferation and tubular atrophy/interstitial fibrosis increased,Logistic regression analysis indieated that there was a positive correlation bet.ween the degree of urinary protein and hypertension,serum uric acid,cholesterol,serum albun in and endocapillary proliferation.8.The age,incidence of renal insufficiency,incidence of tubular atro phy/interstitial fibrosis,serum uric acid,24-hour proteinuria,serum creat inine,urea nitrogen,cholesterin and triacylglycerol level in hypcrtension group were signiricantly higher than those in orthoarteriotony group(P<0.01),and eGFR levels in hypertension group was lower than that in orth oarteriot.ony group(P<0.01).Logistie regression analysis discovered that there was a correlation between age and serum uric acid.9.Compared with normal renal function group,the proportion of males,age,incidence of hyperuricemia,incidence of hyperlipidaemia,incidence of hypertension,systolic blood pressure,diastolic pressure,serum uric acid,24-hour urinary protein quantity,scrum creatinine,urea ni trogen,cholesterin and triacylglycerol level are higher in abnormality renal function group,while scrum albumin,hematocrystallin,eGFR level are lower in renal dysfunction group(P<0.05).The incidence of mesangial hypercellularity,segmental glomerulosclerosis and tubular atrophy/interstitial fibrosis are higher in renal insuffieiency group.By logistic regression analysis,renal function decline was associated with age and serum uric acid.10.Spleen and kidney qi deficiency syndrome was the most common type of syndrome,235 cases(64.4%),followed by deficiency type of both Qi a nd Yin,77 cases(21.1%),Yin deficiency of liver and kidney syndrome,24 cases(6.6%),Yang deficiency in spleen and kidney syndrome,18cases(4.9%),lung kidney qi derieiency syndi-ome 11 eases(3.0%).In the youth group(18?404years old),194cases(67.1%)were mainly spleen-kidney qi asthenia,followed by insufficient of both Qi and Yin syndrome in 68 cases(23.5%),Yin insuffic of liver and kidney syndrome in 16 cases(5.5%),qi inadequate of lung and kidney syndrome 8 cases(2.8%),Yang insufficient in spleen and kidney syndrome 3 cases(1.0%).In the middle aged group(45?59 years old),there were 41 cases with spleen and kidney qi insufficient(59.4%),followed by 10 cases with the Yang deficiency of spleen and renal(14.5%),8 cases wfith inadequate of qi and yin(11.6%),7 cases wi th Yin insufficient of liver and kidney(10.1%)and 3 cases with qi inadeq uate of lung and kidney syndrome(4.3%).In the elderly group(?60years o 1d),the majority was the Yang insufficient of spleen and renal,5 cases(71.4%),followed by inadequate of both Qi and Yinsyndrome(1 cases,14.36%),Yin-insufficient of liver and kidney syndrome(1 cases,14.3%).11.The age of spleen afid kidney yang deficiency is higher than the o ther groups.The incidence of hypertension in liver and kidney yin deficiency is higher than the other groups.The incidence of hyperuricemia,24-hour urinary protein qlantity is lower in insufficient of both Qi and Yin syndrome than spleen-kidney qi asthenia,Yin insufficient of liver and kicdney syndrome and Yang deficiency in spleen and kidney syndrome.Serum uric acid level is lower in insufficient of both Qi and Yin than spleen-kidney qi asthenia,Yin inadequate of liver and kidney syndrome;systolic blood pressure and triacylglycerol are higher in Yin inadequate of liver and kidney and Yang insufficient of spleen and renal than that of other tnree syndromes;while eGFR of Yin inadequate of liver and kidney syndrome and Yang insufficient in spleen and kidney syndrome was lower than thatof spleen-kidney qi asthenia and insufficient of qi-yin;diastolic pressure of Yin insufficient of liver and kidney syndrome is higher than that of other sserum albumin and hemoglobin of spleen-kidney yang defieiency are lower than that of others(P<0.05).endocapillary proliferat.ion of Yang inadequ ate in spleen and kidney syndrome is higher than spleen-kidney qi astheni a,Yin insufficient of liver and kidneyy,insufficient of both Qi and Yin;tubular atrophy/interstitial fibrosis of insufficient of both Qi and Yin islower than spleen-kidney qi asthenia,Yin asthenia of liver and kidney syndrome and Yang insufficient in spleen and kidney syndrome;tubular atrop hy/interstitial fibrosis of Yin asthenia of liver and kidney is higher than that of asthcnja of spleen and kidney Qi.Conclusion1.Immunoglobulin A nephropathy is more commonn Young and middle-aged,The ratio of male to female patients is nearlyl.Chronie nephritis syndrome is the main clinical manifestation,with hematuria,proteinuria,hypertension and renal insufficiency.2.The clinical manifestation is more serious in male,old age nation t,and pathological injury is more serious in middle and elderly patient s.3.Clinical manifestal ion,proportion of mtile and pathological injury was severe in IgAN patients with hyperuricemia.4.The Incidence of renal insuffieiency and serum urie acid level of IgAN patients with moderate-severe urinary protein is higher than that of IgAN patients with mild urinary protein,,the Incidence of segmental glo morulosclerosis of IgAN patients with moderate urinary protein is higher than that of IgAN patients with nild urincry protein.With urinary protern,the morbidity of hypertension,hyperlipidemia,systol ic blood pressure,d i astolic pressure,serum creatinine,urea nitrogen,cholesterin,triacylglyc erol increased,Logistie regression analysis manifested that there was a positive correlation between the degree of urinary protein and hyperte nsion,serum uric acid,cholesterol,serum albumin and endocapillary prolife ration.5.The incidence of tubular atrophy/interstitial fibrosis in hyperten sion group wore significantly higher than that in normal blood pressure group.Logistic regression analysis indicated that there was a correlation between age and serum urie acid.6.The incidence of mesangial hypercellularity,segmental glomeruloscle rosis and tubular atrophy/interstit.ial fibrosis are higher in renal insuf ficiency group.By logistic regression analysis,renal function decline was associated with age and serum uric acid.7.spleen-kidney qi ast.henia syndrome was most commonly in all IgAN patients.spleen-kidney qi astheniavras most commonly in young and middle-age group,and spleen and kidney yang deficiency was most commonlyon in old age group.8.The age of spleen and kidney yang deficiency is higher than the other groups;serum albumin and hemoglobin of spleen-kidney yang defieiency are lower than that of other four deficiency syndromes;the ineidence of endocapillary proliferation of spleen-kidney yang deficiency is higher;The incidence of hypertension in liver and kidney yindeficiency is higher than the other groups.tubular atrophy/interstitial fibrosis of Yin insufficient of liver and kidney is higher than that of spleen-kidney qia sthenia.EGFR of Yin insuffieient of liver and kidney and Yang asthenia in spleen and kidney syndrome was lower,while triglyceride is higher.24 hours urine protein,incidence of hyperurieemiaand incidence of tubular atrophy/interstitial fibrosis are lower in Qi and yin deficiency syndrome.