IgA肾病中医湿热证微观辨证病理指标的研究.docVIP

IgA肾病中医湿热证微观辨证病理指标的研究 　　摘要：目的 探讨IgA肾病中医湿热证微观辨证相关性病理指标，为IgA肾病湿热证候诊断寻找客观依据。方法 多家医院协作收集数据，对研究对象根据湿热证诊断标准进行中医辨证并量化评分，同时行肾穿刺活检病理诊断，判断IgA荧光强度，进行牛津分类、Katafuchi积分和蒋氏评分，分析湿热证与微观病理指标的关系。结果 湿热证IgA+++～++++相对占比较高，IgA+++与IgA++++中湿热证组占比明显高于非湿热证组；湿热证组节段性肾小球硬化或粘连占比、肾小球节段病变及间质炎性细胞浸润Katafuchi评分、破坏毛细血管袢活动性病变蒋氏评分显著高于非湿热证组；湿热证与上述病理指标评分呈显著正相关，与肾小球球性硬化、肾血管透明变性评分呈显著负相关。结论 IgA肾病湿热证与部分病理特征具有相关性，将相关性病理指标引入IgA肾病微观辨证之中可提高辨证准确率。 　　关键词：IgA肾病；湿热证；微观辨证；病理指标 　　DOI：10.3969/j.issn.1005-5304.2015.08.009 　　中图分类号：R272.969.2 文献标识码：A 文章编号：1005-5304（2015）08-0031-05 　　Study on Pathological Indicators in TCM Microcosmic Syndrome Differentiation in Dampness-heat Syndrome of IgA Nephropathy WANG Xin-rong1， WAN Ting-xin1， ZHAO Zhu-hua1， WANG Wen-ge2， LI Yin-xia1， YANG Bai-quan3， LI Jian-zhong1， LU Xin-qiang1 （1.Wuwei City Hospital， Wuwei 733000， China；2.Lanzhou University Second Hospital， Lanzhou 730000， China；3.Liangzhou District Hospital in Wuwei City， Wuwei 733000， China） 　　Abstract：Objective To explore the association of pathological indicators with TCM microcosmic syndrome differentiation in dampness-heat syndrome of IgA nephropathy；To find the objective evidence of diagnosis for dampness-heat syndrome of IgA nephropathy. Methods A prospective study was conducted to collect data in multi clinical centers. Patients were diagnosed with TCM syndrome type according to the dampness-heat syndrome diagnostic criteria. Meanwhile， all patients were performed percutaneous renal biopsy， by which the immunofluorescence intensity of IgA nephropathy was assessed. Hass， Oxford， Katafuchi and Jiang’s classification methods were used to calculate scores to analyze the relationship of dampness-heat syndrome type and pathological indicators. Results The levels of fluorescence intensity were mainly graded as Ⅲ-Ⅳ in patients of dampness-heat syndrome， but the grades Ⅲ and Ⅳ were significantly higher in dampness-heat syndrome than in others. In the Katafuchi scoring method， the scores for segmental glomerular sclerosis or