儿童紫癜性肾炎中医证型与肾脏病理和尿Podocalyxin的关系研究

发布时间：2018-02-21 18:35

本文关键词： 儿童紫癜性肾炎中医证型病理分级足细胞尿Podocalyxin　出处：《南京中医药大学》2012年博士论文　论文类型：学位论文

【摘要】：目的：提出紫癜性肾炎的中医证候学相关指标,探讨儿童紫癜性肾炎的中医辨证分型；分析儿童紫癜性肾炎中医证型和临床特点、病理学分级、免疫荧光分型、足细胞损伤、尿Podocalyxin之间的关系。方法：前瞻性研究南京军区南京总医院儿科2010年1月1日至2011年9月1日符合病例选择标准的儿童紫癜性肾炎住院病例共126例,调研有关文献,提出中医辨证指标,对患儿指标进行聚类分析和单变量分析,判定患儿中医证型；对其中72例患儿进行肾穿刺活检和尿Podocalyxin检测。肾组织病理除常规进行病理分级和免疫荧光分型外,还在电镜下观察肾小球足细胞损伤程度,按照足突融合情况进行分类。分析各中医证型和临床特点、肾组织病理、尿Podocalyxin的关系。结果：本组资料126例HSPN患儿中医证型分为四型：风热伤络证42例,占33.3%；血热扰肾证39例,占31%；肾阴不足证34例,占27%；气阴两虚证11例,占8.7%。病理分级按照ISKDC分类集中在Ⅱ级和Ⅲ级,其中病理分级为Ⅱ级的患儿34例,占47.2%；病理分级为Ⅲ级的患儿38例,占52.8%。免疫荧光分型：单纯IgA型患儿13例,占18.1%；IgA+IgG型患儿31例,占43.1%；IgA+IgM型患儿6例,占8.3%；IgA+M+G型患儿22例,占30.6%。电镜下观察肾小球足细胞损伤情况：足突广泛融合21例,足突节段融合35例和无足突融合11例。5例电镜下未见肾小球。肾阴不足证患儿中病程1个月者比风热伤络证多(P0.05)；气阴两虚证患儿中病程1个月者比风热伤络证和血热扰肾证多(P0.05)。各中医证型在不同年龄、性别的分布无统计学明显差异(P0.05)。风热伤络证较其他证型合并前驱感染的患儿多(P0.05)。风热伤络证和肾阴不足证患儿临床表现多为血尿和蛋白尿,而气阴两虚证多表现为肾病综合征(P0.05)。血热扰肾证患儿以Ⅱ级病变为主,肾阴不足证患儿以Ⅲ级病变多见；实证患儿病理分级多为Ⅱ级,虚证患儿病理分级多为Ⅲ级(P0.05)。风热伤络证患儿免疫荧光分型多为IgA+IgG型,肾阴不足证患儿免疫荧光分型多为IgA+M+G型(P0.05)。风热伤络证和血热扰肾证患儿均以足突节段融合最多,肾阴不足证和气阴两虚证患儿中均以足突广泛融合最多。足突广泛融合患儿病理分级为Ⅲ级者较足突节段融合、无足突融合者多(P0.05)。风热伤络证和血热扰肾证患儿尿液Podocalyxin值低于肾阴不足证、气阴两虚证患儿(P0.05)；孤立性蛋白尿型患儿尿中Podocalyxin检测值较孤立性血尿型高,较肾病综合征型低(P0.05)；病理分级为Ⅲ级的患儿和病理分级为Ⅱ级的患儿比较,尿中Podocalyxin检测值高(P0.05)。结论：紫癜性肾炎患儿随着病史迁延、病情发展,中医证型从风热伤络证、血热扰肾证进展为肾阴不足证或气阴两虚证;不同中医证型的临床表现有差异；虚证患儿病理改变较实证患儿严重,虚证患儿免疫球蛋白沉积种类较实证患儿多。足细胞损伤程度也随着中医证型的发展而加重,表现为电镜下足突融合程度加重、尿中Podocalyxin检测值升高。足细胞损伤情况越重病理改变越明显。
[Abstract]:Objective : To study the syndrome differentiation of TCM syndrome of Henoch - Schonlein - Schonlein purpura nephritis , and to analyze the relationship between syndrome type and clinical characteristics , pathological grade , immunofluorescence typing , foot cell injury and urine Podocalyxin in children with purpura nephritis . Methods : A prospective study of 126 cases of pediatric purpura nephritis hospitalized from January 1 , 2010 to Sep . 1 , 2011 in Nanjing General Hospital of Nanjing Military Region was conducted . Results : There were 42 cases of children with HSPN syndrome : 42 cases of wind - heat injury syndrome , 33 . 3 % , 39 cases of syndrome of kidney yin deficiency syndrome ( P < 0.05 ) . Conclusion : Children with Henoch - Schonlein purpura nephritis with the history of medical history , the development of the disease , the TCM syndrome type from the wind - heat injury collateral syndrome , the blood heat - disturbance kidney syndrome progression is the kidney - yin deficiency syndrome or the qi - yin deficiency syndrome ; the clinical manifestation of the syndrome type of deficiency syndrome is more than that of the positive case . The degree of foot cell injury also increases with the development of the traditional Chinese medicine syndrome type , and the Podocalyxin detection value in the urine increases . The more obvious the pathological change is in the case of foot cell injury .

【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R272

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