| ObjectiveTo investigate the general characteristics,clinical and pathological features,and the distribution of TCM syndromes in patients with mesangial proliferative glomerulonephritis in Guangdong,and to further study the correlation between age,clinical indexes and pathological changes of mesangial proliferative glomerulonephritis and TCM syndromes.To provide a rational theoretical basis for clinical practice.MethodsA total of 258 cases of MsPGN confirmed by renal biopsy in outpatient and ward of Kidney Center of Guangdong Provincial Hospital of Chinese Medicine Hospital were collected from January 2010 to December 2020.The patients’ complete history,TCM syndromes,treatment general situation,clinical and pathological data were retrospectively studied,and the statistics were analyzed by SPSS17.0 software.According to sex,age,hyperuricemia,hypertension and renal function level were grouped to compare their clinical,pathological characteristics and the correlation of TCM syndrome type.Results1.A total of 258 patients with MsPGN,the ratio of male to female was 1.05:1.The age was 36.08±11.01 years old(18 to 74 years old).The time from onset to renal biopsy was 2 to 7000 days.The average course of disease was 277.50(69.50,741.50)days.Age from 18 to 40 years old was youth group,which’s total case was 197(76.4%).while the 41 to 74 years old was the middle and old aged group with the total case number of 61(23.6%).The 24 hours urine protein quantification was 1.38(0.66,3.62)g,and serum albumin 38.04±6.03 g/L.Patient with Nephrotic syndrome were 39(15.1%).Hematuria were 239 cases(92.6%).There were 103 patient with hypertension(39.9%),between which their systolic pressure were 131.84±18.79mmHg,diastolic pressure were 84.35±13.45mmHg.There were 166 cases with hyperuricemia(64.3%).2.Compared with the female group,the clinical manifestations of the male group were higher levels of serum albumin,serum creatinine,serum uric acid and hemoglobin.The difference was statistically significant(P<0.05).There were no significant differences in mesangial hyperplasia score,global glomerular sclerosis score,tubular fibrosis score and segmental glomerular sclerosis score between the two groups(P>0.05).3.Compared with the youth group,the levels of systolic blood pressure,24h urinary protein and triglyceride of the middle and old aged group were higher,while the levels of plasma albumin and eGFR were lower,with a statistically significant difference(P<0.05).Results of various pathologi cal scores in the two groups showed that mesangial hyperplasia score,glomerular global sclerosis score and renal tubular fibrosis score were higher the middle and old aged group,while glomerular segmental sclerosis score was lower.The difference was statistically significant(P<0.05).4.Compared with the mild mesangial hyperplasia group,the onset age,serum uric acid,triglyceride and the incidence of hypertension of the moderate mesangial hyperplasia group was higher.While the index of triglyceride,serum uric acid and the incidence of hypertension was even higher.Compared with other groups,patient in the severe mesangial hyperplasia group had a lower index of plasma albumin level.There was a statistically significant differences in the incidence of nephrotic syndrome,serum creatinine,blood urea nitrogen,24-hour urinary protein,total cholesterol,hemoglobin and eGFR levels among the three groups(P<0.01).Mild mesangial hyperplasia showed no obvious glomerulosclerosis and renal interstitial lesions.The higher the degree of mesangial hyperplasia,the higher the renal tubulointerstitial fibrosis score(P<0.01).5.Compared with the non-IgAMsPGN group,the clinical manifestations of the IgA MsPGN group showed the lower diastolic blood pressure,blood uric acid,but higher incidence of hyperuricemia and higher eGFR level.The difference was statistically significant(P<0.05).There were no significant differences between the two groups in age of onset,duration of disease,incidence of nephrotic syndrome,gender,whether combined hematuria,incidence of hypertension,systolic blood pressure,24 hours proteinuria,plasma albumin,serum creatinine,urea nitrogen,total cholesterol,triglyceride and hemoglobin levels(P>0.05).Compared with the non-IgAMSPGN group,Patient in the IgA MsPGN group had lower scores,including the mesangial hyperplasia scor e,global glomerular sclerosis score and renal tubular fibrosis score,the difference was statistically significant(P<0.05).There was no significant difference in gl omerular segment sclerosis scores between the two groups(P>0.05).6.The main diagnosis of TCM was edema in 157 cases(60.9%),and the Qi Yin two deficiency syndrome was the most common syndrome,82 cases(31.8%),followed by spleen and kidney deficiency,62 cases(24.0%),spleen and kidney yang deficiency in 53 cases(20.5%),liver kidney yin deficiency syndrome 39 cases(15.1%)and lung kidney qi deficiency syndrome 22 cases(8.5%).7.There was no significant difference among all the deficiency syndromes in the aspect of the time from onset to biopsy,gender,incidence of hematuria,hypertension,hyperuricemia,blood uric acid.Compared with the other four deficiency syndromes,patient who had spleen and kidney yang deficiency showed a high level of urine protein,however had a level of hemoglobin and glomerular filtration rate.The serum creatinine,urea nitrogen and total cholesterol of patient with spleen and kidney Yang deficiency were higher than those with lung kidney qi deficiency syndrome,spleen and kidney deficiency,and Qi Yin two deficiency syndrome,while the plasma albumin was lower.The systolic blood pressure and total triglyceride of spleen and kidney Yang deficiency were higher than those who with lung and kidney qi deficiency and qi Yin two deficiency.The diastolic blood pressure of spleen and kidney Yang deficiency was higher than that of spleen and kidney deficiency,and the difference was statistically significant(P<0.05).There were significant differences in renal tubular fibrosis scores and mesangial hyperplasia scores among all the deficiency syndromes(P<0.05).The degree of renal tubular fibrosis and mesangial hyperplasia in spleen and kidney Yang deficiency syndrome was higher than that in the other four syndromes.Multivariate Logistic regression analysis showed that spleen and kidney Yang deficiency in MSPGN patient was related to age,24-hour urinary protein level,total cholesterol level,mesangial hyperplasia score and renal tubular fibrosis score.Conclusion1.MsPGN occurs more frequently in young and middle-aged patients,and male patients are more than female patients.Patients’levels of Proteinuria and hematuria were high,accompany with hypertension and hyperuricemia.Compared with the female group,the male group showed higher levels of serum albumin,serum creatinine,serum uric acid and hemoglobin.2.Compared with the youth group,the the middle and old aged group had higher systolic blood pressure,24h urinary protein and triglyceride levels,lower plasma albumin and eGFR levels,and higher mesangial hyperplasia score,glomerular global sclerosis score and renal tubule fibrosis score.3.The more severe the mesangial hyperplasia,the higher the NS incidence,serum creatinine,serum uric acid,blood urea nitrogen,and 24-hour urine protein quantitative level,and the lower the albumin,hemoglobin,and eGFR levels.Mild mesangial hyperplasia showed no obvious glomerulosclerosis and renal interstitial lesions.The higher the degree of mesangial hyperplasia,the higher the renal tubule fibrosis score.4.Compared with non-IgAMSPGN group,the clinical manifestations of IgAMSPGN group were with lower diastolic blood pressure,lower blood uric acid,higher incidence of hyperuricemia,eGFR level,meanwhile their mesangial hyperplasia score,glomerular global sclerosis score and renal tubulointersti tial fibrosis score were low.5.The most common syndromes of traditional Chinese medicine are Qi Yin two deficiency syndrome,followed by spleen and kidney deficiency,spleen and kidney yang deficiency,liver kidney yin deficiency syndrome and lung kidney qi deficiency syndrome.6.Compared with other syndromes,patient with spleen and kidney Yang deficiency showed the higher age,24h urinary protein ration,but lower hemoglobin and glomerular filtration rate.The degree of renal tubular fibrosis and mesangial hyperplasia is more serious in spleen and kidney Yang deficiency syndrome patient.The spleen and kidney Yang deficiency syndrome was related to age,24-hour urinary protein,total cholesterol,mesangial hyperplasia score and renal tubular fibrosis score. |
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