| Research BackgroundIgA nephropathy(IgA nephropathy,IgAN)is a glomerular disease in which IgA is mainly deposited in the mesangial region of the glomerulus,with or without the deposition of other immunoglobulins.It is a primary renal glomerulus.The most common pathological type of glomerulonephritis.The clinical manifestations of IgAN are diverse.Studies have shown that controlling proteinuria and blood pressure can appropriately delay disease progression,but more research is still needed to explore new therapeutic targets from clinical and pathological perspectives in order to further improve the clinical efficacy of IgAN.Vascular lesions are common in the renal pathological manifestations of IgAN patients,but the research on the prognosis of IgAN is controversial,and the characteristics of TCM syndromes in IgAN patients with vascular lesions are not clear.Therefore,this study initially explores the TCM syndromes of IgAN with-vascular lesions.Symptoms and clinicopathological characteristics,in order to deepen the understanding of IgAN.ObjectiveTo preliminarily explore the TCM syndromes and clinicopathological characteristics of IgAN patients with vascular disease.MethodA single-center retrospective cross-sectional study method was used to collect kidney tissue biopsy from Guang’anmen Hospital of China Academy of Chinese Medical Sciences from July 1,2004 to December 31,2020,which were clearly diagnosed as primary IgAN and met the inclusion and exclusion criteria of this study.There are a total of 226 patients.According to the type and degree of vascular disease in renal pathology,89 cases were divided into avascular disease group and 137 cases with vascular disease group.The clinical and renal pathological data of the two groups of patients were collected and compared,and the TCM syndromes,clinical and pathological characteristics of IgAN patients with vascular disease were preliminarily discussed.Results1 normal information1.1 GenderComparison of gender distribution between the avascular disease group and the vascular disease group:male(57.3%vs 56.9%)and female(42.7%vs 43.1%).There was no significant difference between the two groups(P=0.956>0.05).1.2 AgeThe median age of patients in the avascular disease group was 39.00(17.00)years,and the median age of patients in the vascular disease group was 39.00(19.00)years.There was no significant difference between the two groups(P=0.360>0.05).1.3 Course of disease(time from onset to kidney biopsy)The median duration of the disease course between the avascular disease group and the vascular disease group was 12.00(46.00)months,and the difference was not statistically significant(P=0.876>0.05).1.4 Personal history of tobacco and alcohol and family history of hypertensionPersonal history of smoking and alcohol:comparison between the group without vascular disease and the group with vascular disease:no history of smoking and alcohol(73.0%vs 65.7%),history of smoking and alcohol and no history of withdrawal(13.5%-vs 20.4%),incomplete smoking and alcohol quitting History of discontinuation(6.7%vs 5.8%),history of complete smoking and alcohol withdrawal(6.7%vs 8.0%),there was no significant difference between the two groups(P=0.554>0.05).Family history of hypertension:comparison between the group without vascular disease and the group with vascular disease:there is family history(31.5%vs 30.7%),no family history(68.5%vs 69.3%),there is no statistically significant difference between the two groups(P=0.898>0.05).1.5 Past historyComparison between the avascular disease group and the vascular disease group:hypertension(14.6%vs 28.5%,P=0.016<0.05),abnormal uric acid(27.0%vs 46.7%,P=0.003<0.01),fundus disease(4.5%vs 11.7%,P=0.063>0.05),dyslipidemia(43.8%vs 52.6%,P=0.199>0.05),and involving large vessel disease(14.6%vs 15.3%,P=0.882>0.05).Compared with the avascular disease group,the vascular disease group had a higher proportion of hypertension and abnormal uric acid in the past.2 TCM syndrome data2.1 Distribution of main symptoms of TCMThe main symptoms of traditional Chinese medicine in the avascular disease group and the vascular disease group in descending order of occurrence rate are as follows:fatigue(57.3%vs 62.8%),foamy urine(53.9%vs 55.5%),lumbar discomfort(57.3%vs 48.9%),Edema(29.2%vs 29.2%),nocturia(28.1%vs 24.1%),dry mouth(24.7%vs 31.7%),abnormal stool(35.8%vs 19.0%),dizziness(12.4%vs 20.4%),pharynx Pain(13.5%vs 4.6%),bitter mouth(14.6%vs 11.7%),chills(9.0%vs 10.9%),spontaneous sweating(5.6%vs 3.6%)and night sweats(6.7%vs 1.5%),there are no statistically significant differences between the two groups(P all>0.05).2.2 Distribution of TCM syndromes(1)The distribution of the deficiency of TCM in the avascular disease group and the group with vascular disease:deficiency of lung and spleen Qi(46.1%vs 42.3%)>deficiency of Qi and Yin(30.3%vs 23.4%)>deficiency of spleen and kidney(20.2%vs 28.5%)>Liver and kidney yin deficiency syndrome(3.4%vs 5.8%),there was no significant difference between the two groups(P=0.339>0.05).(2)The distribution of TCM standard empirical evidence in the avascular disease group and the vascular disease group:blood stasis syndrome(21.3%vs 35.8%,P=0.021<0.05),damp-heat syndrome(34.8%vs 21.9%,P=0.032<0.05),Phlegm-dampness syndrome(28.1%vs 24.1%,P=0.501>0.05),water-dampness syndrome(4.5%vs 10.9%,P=0.088>0.05),exogenous wind-heat syndrome(6.6%vs 9.0%,P=0.252>0.05)),turbid poisoning syndrome(2.2%vs 2.2%,P=0.977>0.05).Compared with the avascular disease group,the blood stasis syndrome is higher in the vascular disease group,and the damp-heat syndrome is lower.3 Clinical data3.1 Body mass indexComparison between the avascular disease group and the group with vascular disease:[(25.17±3.67)vs(24.81 ± 4.20),P=0.523>0.05].3.2 HypertensionComparison between the avascular disease group and the group with vascular disease:Grade 0(39.3%vs 20.4%,P=0.002<0.01),Grade 1(27.9%vs 30.7%,P=0.551>0.05),Grade 2(14.6%vs 15.3%,P=0.882>0.05),grade 3(19.1%vs 33.6%,P=0.018<0.05).Compared with the avascular disease group,the proportion of grade 0 of hypertension in the group with vascular disease was lower,and the proportion of grade 3 was higher.3.3 Urine red blood cell count and 24-hour urine protein quantification under high magnificationUrine red blood cell count under high magnification:Compared with the non-vascular disease group,the high magnification urine red blood cell count in the vascular disease group was lower[19.86(40.29)vs 9.41(23.40),P=0.037<0.05].24-hour urine protein quantification:Compared with the avascular disease group,the 24-hour urine protein quantification level of the group with vascular disease was higher[1.48(1.49)vs 1.73(2.10),P=0.038<0.05].The 24-hour urine protein quantitatively divided into three levels:Comparison between the avascular disease group and the group with vascular disease:<1 g/24h(34.1%vs 24.8%),1 g/24h<24-hour urine protein quantitative<3.5 g/24h(58.0%vs.59.9%),≥ 3.5 g/24h(8.0%vs 15.3%),there was no statistically significant difference between the two groups(P=0.136>0.05).3.4 Renal function and CKD stagingComparison of various renal functions between the avascular disease group and the vascular disease group:blood creatinine(Scr)[86.00(37.50)vs 110.50(70.20),P=0.000<0.01],blood urea nitrogen(BUN)[5.30(2.53)vs 7.03(3.77),P=0.000<0.01],eGFR[(89.72 ±31.47)vs(65.45±38.67),P=0.000<0.01].Compared with the avascular disease group,the renal function of the vascular disease group was worse.Comparison of CKD staging between the avascular disease group and the vascular disease group:CKD stage 1(46.1%vs 18.2%,P=0.000<0.01),CKD stage 2(38.2%vs 38.7%,P=0.942>0.05),CKD stage 3a(11.2%vs 15.3%,P=0.382>0.05),CKD stage 3b(4.5%vs 17.5%,P=0.004<0.01),stage 4(0.0%vs 10.2%,P=0.002<0.01).Compared with the avascular disease group,the proportion of CKD stage 1 in the group with vascular disease was lower,and the proportion of CKD stage 3 a and stage 4 was higher.3.5 Other biochemical indicators3.5.1 HemoglobinCompared with the avascular disease group,the hemoglobin level of the vascular disease group was lower[140.00(34.50)vs 134.00(28.50),P=0.027<0.05].3.5.2 Serum albumin and blood uric acidSerum albumin:Compared with the avascular disease group,the serum albumin level in the vascular disease group was lower[39.60(8.75)vs 37.85(7.60),P=0.011<0.05].Blood uric acid:Compared with the non-vascular disease group,the blood uric acid level in the vascular disease group is higher[352.00(146.00)vs 416.00(163.25),P=0.001<0.01].3.5.3 Blood lipid related indicatorsComparison between the avascular disease group and the vascular disease group:serum cholesterol[4.83(1.45)vs 5.03(1.87),P=0.529>0.05],triglycerides[1.91(1.56)vs 1.78(1.50),P=0.482>0.05],low density lipoprotein[3.04(1.17)vs 3.00(1.12),P=0.506>0.05],high density lipoprotein[1.16(0.41)vs 1.16(0.40),P=0.758>0.05].3.5.4 Electrolyte related indicatorsComparison of the avascular disease group and the vascular disease group:bicarbonate[24.25(2.90)vs 23.25(4.07),P=0.103>0.05],serum potassium[4.15(0.50)vs 4.30(0.48),P=0.008<0.01],serum Calcium[2.32(0.18)vs 2.30(0.21),P=0.152>0.05],serum phosphorus[1.20(0.29)vs 1.24(0.29),P=0.062>0.05].Compared with the avascular disease group,the serum potassium level in the vascular disease group was higher.3.6 Serum complement levelComparison between the avascular disease group and the vascular disease group:serum IgA[3.16(1.58)vs 2.96(1.51),P=0.132>0.05],serum IgM[0.98(0.69)vs 0.94(0.64),P=0.561>0.05],Serum C3[0.96(0.32)vs 0.94(0.27),P=0.416>0.05)],serum C4[0.24(0.09)vs 0.236(0.09),P=0.335>0.05].4 Pathological data4.1 Oxford Pathological ClassificationComparison between the avascular disease group and the vascular disease group:the proportion of mesangial cell proliferation(67.4%vs 89.8%,P=0.000<0.01),the proportion of capillary endothelial cell proliferation(25.8%vs 31.4%,P=0.82>0.01).The proportion of glomerular segmental sclerosis(48.3%vs 70.8%,P=0.001<0.05),the proportion of renal tubular atrophy or interstitial fibrosis(9.0%vs 93.4%,P=0.000<0.01),the proportion of crescent formation(50.6%vs 67.2%,P=0.013<0.05).Compared with the avascular disease group,the mesangial cell proliferation,glomerular segmental sclerosis,renal tubular atrophy or interstitial fibrosis,and crescent formation in the vascular disease group were higher.4.2 ImmunofluorescenceComparison between the avascular disease group and the vascular disease group:IgG deposition ratio(13.5%vs 10.5%,P=0.502>0.05,IgM deposition ratio(58.3%vs 54.1%,P=0.395>0.05,C3 deposition ratio(94.4%vs 94.0%,P=0.395>0.05,C1q deposition ratio(5.6%vs 10.5%,P=0.732>0.05,FRA deposition ratio(7.8%vs 10.6%,P=0.701>0.05).Conclusions(1)TCM syndromes:The main symptoms of IgAN patients with vascular disease are fatigue and backache.The main symptoms of this deficiency are mainly deficiency of lung,spleen and qi,and yang deficiency of spleen and kidney.The main symptoms are blood stasis and phlegm-dampness.(2)Clinical features:IgAN patients with vascular disease usually have abnormal uric acid,a history of hypertension,poor basic renal function,more proteinuria,fewer red blood cells in the urine,and low hemoglobin and serum albumin;(3)Kidney pathological characteristics:IgAN patients with vascular disease have mesangial cell proliferation,glomerular segmental sclerosis,renal tubular atrophy or interstitial fibrosis,and a high proportion of crescent formation. |
PDF Full Text Request