体质、证型、皮肤黏膜炎症与肾脏病理关系的探索
发布时间：2018-07-23 08:23
【摘要】：目的：1.比较皮肤黏膜炎症在慢性肾炎与普通人群中的发病情况2.鉴于文献中已证实皮肤黏膜炎症与IgA肾病的因果关系,我们以IgA肾病作为模型,研究皮肤黏膜炎症在IgA肾病人群中为什么高发,与哪些因素有关,探索反复发生的原因及可能的防治对策。3.比较不同病理类型慢性肾炎患者群体中皮肤黏膜炎症的发病情况,找出不同病理类型之间有差异的各种临床指标,为采用临床表型预测肾脏病理类型做出初步探索4.鉴于以往的研究发现一种证型可以包含多种体质,我们进一步探讨体质、证型共同对慢性肾炎临床病理的影响方法：1.收集85例肾源性孤立性镜下血尿患者和85例普通人群的皮肤黏膜炎症的资料进行病例对照研究,比较皮肤黏膜炎症在慢性肾炎与普通人群的发病情况。2.采用流行病学现场调查方法,收集162例IgA肾病患者皮肤黏膜炎症、炎症诱因及中医体质的资料,研究皮肤黏膜炎症在IgA肾病人群中的高发原因,分析中医体质与皮肤黏膜炎症、炎症诱因的相关性,探索可能的防治对策。3.采用流行病学调查方法,收集226例已行肾活检明确病理类型的慢性肾炎患者皮肤黏膜炎症、临床特征、中医体质及中医证型的资料,比较不同病理类型慢性肾炎患者群体中皮肤黏膜炎症的发病情况,找出不同病理类型之间有差异的各种临床指标。4.研究方法和调查内容同第三部分,收集104例脾肾气虚型IgA肾病不同体质的临床资料和102例膜性肾病不同体质的临床资料,分析体质、证型共同对肾脏临床病理的影响,为病理预后判断提供依据。结果：1.慢性肾炎与普通人群皮肤黏膜炎症患病率比较肾源性孤立性血尿病例组和对照组基线资料无差异,皮肤黏膜炎症比较显示：血尿组有皮肤黏膜炎症的发生率比对照组高,炎症种类越多,两组比较越有统计学意义。不同种类的皮肤黏膜炎症比较中,每年有无感冒、感冒≥3次／年,每年有无口腔溃疡、口腔溃疡≥2次／年,慢性咽炎、慢性扁桃体炎、慢性鼻炎、反流性食管炎、慢性皮肤病两组差异有统计学意义。急性炎症如感冒和口腔溃疡,每年发作次数越多,两组比较越有统计学意义。为什么反复或慢性皮肤黏膜炎症在慢性肾炎群体中发病率很高?这些皮肤黏膜炎症的发生与哪些因素有关?它们与肾脏病的发生和发展有什么关系?2.IgA肾病皮肤黏膜炎症及相关因素的调查研究2.1 162例IgA肾病患者一般情况分析162例患者中男性92例,女性70例,平均年龄为35.9±12.5岁,平均病程42.9±35.5月,其中以肾病综合征起病有1 9例(11.7%),以肉眼血尿起病有25例(15.4%),起病时伴镜下血尿有150例(92.6%)。2.2 162例患者的中医体质分布162例IgA肾病患者中医体质分布以平和质78例(48.1%),气虚质23例(14.2%),阳虚质20例(12.3%)为主。兼夹体质有三种,气郁质7例(4.3%),特禀质15例(9.3%),和血瘀质6例(3.7%)。2.3 IgA肾病患者的皮肤黏膜炎症分布反复或慢性皮肤黏膜炎症一共有9种,其中有炎症141例(87%),无炎症有21例(13%),慢性鼻炎患者24例(14.8%),慢性咽炎61例(37.7%),慢性扁桃体炎28例(17.3%),牙龈炎或牙周炎68例(42%),反复口腔溃疡28例(17.3%),反复上呼吸道感染43例(26.5%),慢性肠炎35例(21.6%),慢性胃炎或十二指肠溃疡31例(19.1%),皮肤炎症(荨麻疹或痤疮)71例(43.8%)。一个患者可有多种皮肤黏膜炎症炎症,数目多集中在2-3种。2.4皮肤黏膜炎症的诱因分布我们调查了反复或慢性皮肤黏膜炎症的诱因分布,主要是气候变化70例(43.2%),饮食因素37例(22.8%),失眠因素44例(27.2%),劳累因素48例(29.6%),情绪因素11例(6.8%),过敏因素19例(11.7%)。2.5中医体质与炎症类型比较9种炎症类型与中医体质比较发现,某些炎症在不同体质之间存在分布差异,慢性鼻炎,气虚质比平和质发病率高,有统计学意义。与平和质相比,反复上呼吸道感染气虚质和阳虚质发病率高,有统计学意义。与平和质相比,慢性胃炎或十二指肠溃疡,阴虚质发病率高,有统计学意义。和平和质相比,湿热质反复或慢性皮肤炎症发病率高,有统计学意义(P0.05)。2.6中医体质与炎症诱因的比较在体质与炎症诱因的比较中我们也发现,在不同黏膜炎症诱因下体质分布有差异,例如气候变化的诱因导致的炎症以气虚质和阳虚质患者比例较高,与平和质和痰湿质比较有统计学意义,饮食因素诱发或加重皮肤黏膜炎症的患者以湿热质和阴虚质较多,与平和质和阳虚质相比,有统计学意义。过敏因素诱发炎症患者以痰湿质居多,与平和质相比有统计学意义(P0.05)。皮肤黏膜炎症在IgA肾病患者中发病率很高,与中医体质相关,那么在其他病理类型的慢性肾炎中发病情况如何?体质、证型能否用于预测慢性肾小球肾炎的不同病理类型?3.不同病理类型慢性肾炎的皮肤黏膜炎症比较及临床表型初步探索3.1 226例患者的一般基线资料226例患者年龄大多集中在18岁到55岁之间,男性133例,女性93例,病程中位数为38(12,48)月,其中局灶节段硬化型肾小球肾炎1例(0.4%),IgAN组136例(60.2%),MN伴系膜IgA沉积(IgA+MN)组患者有15例(6.6%),MN患者有61例(27%),MCD组为13例(5.8%)。3.2 226例患者的中医证型和中医体质资料226例患者中有3例缺少中医体质和证型的资料,余223例患者进行统计分析,其中中医证型分布以脾肾气虚152例(68.2%)和脾肾阳虚48例(21.5%)居多,标证分布以水湿证32例(14.3%),湿浊证48例(21.5%),湿热证58例(26%),血瘀证32例(14.3%)较为常见。中医体质中以平和质78例(35.4%)最多,其次是气虚质29例(13.0%),阳虚质39例(17.5%),痰湿质40例(17.9%)。3.3皮肤黏膜炎症对慢性肾炎不同病理类型的影响FSGS例数较少,故未纳入比较。结果显示慢性鼻炎、慢性咽炎、反复或慢性牙龈炎/牙周炎、反复皮肤痤疮在不同病理分布中差异有统计学意义(P0.05),两两比较后反复或慢性牙龈炎/牙周炎以IgA+MN、MN患者居多,与IgAN比较有统计学意义,IgA+MN比例高于MCD。IgAN上呼吸道炎症和皮肤炎症居多,和MN相比有统计学意义(P0.05)。3.4慢性肾炎不同病理类型临床参数的比较列出了20种有统计学意义的指标,包括年龄、病史、临床指标、中医体质和证型等,进一步两两比较后发现,IgAN年龄、肾病综合征比例、肾功能异常比例、24小时尿蛋白、白蛋白、血肌酐与其他三组比较有统计学意义(P0.01),MCD患者年龄低于MN(P0.01),MN组血清IgA、C3低于IgAN组,IgE高于IgAN组,结果有统计学意义(P0.01),体质与证型比较中,MCD组脾肾阳虚证和阳虚质比例较高,与IgAN组相比有统计学意义(P0.01),IgAN痰湿质比例较高,与MN组比较有统计学意义(P0.01)。在本研究中,发现不同病理类型肾炎之间中医体质和证型分布有差异,我们以往的研究还发现有时一种证型可以包含多种体质,而这些是否会对肾脏临床病理产生影响?4.中医体质、证型与慢性肾炎临床病理的相关研究4.1脾肾气虚型IgA肾病不同体质的临床病理比较4.1.1三种体质肾脏病理Katafuchi积分以及临床指标比较我们纳入了104例脾肾气虚型患者,中医体质辨识主要为三种体质,平和质40例、气虚质19例和夹湿体质(包括湿热质和痰湿质)45例。气虚质肾小球积分低于平和质,夹湿质肾血管积分高于平和质,差异有统计学意义,肾小球积分和总积分都有气虚质最低,其次平和质,夹湿质最高的趋势。总胆固醇、甘油三酯、肌酐和尿酸的比较中都有气虚质最低,其次是平和质,夹湿质最高的趋势。4.2膜性肾病不同体质的临床病理比较4.2.1基线和病理比较102例膜性肾病中,中医证型主要为脾肾气虚68例(64.2%)和脾肾阳虚30例(28.3%),肺肾气虚1例(0.9%)、气阴两虚2例(1.9%)、阴阳两虚1例(0.9%)例数较少未纳入比较。随访中无特禀质、气郁质及血瘀质,痰湿质和湿热质均为夹湿体质,因各自例数偏少,故合并为一组,脾肾阳虚型患者除阳虚质以外,其他体质例数较少,故合并为非阳虚质一组。其中平和质43例(42.2%),气虚质11例(10.8%),夹湿质14例(13.7%),阳虚质24例(23.5%),非阳虚质6例(5.9%)。这五种体质在年龄、病程、高血压分布中无统计学意义。五组患者性别分布有统计学意义。体质指数比较中,脾肾气虚型患者三种体质中平和质、阳虚质最低,气虚质、非阳虚质其次,夹湿质最高,差异有统计学意义。脾肾气虚夹湿型患者的Ⅱ期膜性肾病的比例高于其他体质类型,其次是平和质脾肾气虚型,气虚质脾肾气虚型比例最小,差异有统计学意义。4.2.2五种体质实验室检查结果比较肾功能方面,夹湿质血肌酐高于气虚质和阳虚质。24小时尿蛋白中,夹湿质最高。血肌酐和24小时尿蛋白比较中都有气虚质最低,平和质其次,夹湿质最高的趋势。阳虚质临床病理比较并不比非阳虚质重。结论：1.皮肤黏膜炎症在肾源性血尿患者中发病率更高。其中每年有无感冒,感冒≥3次/年、慢性咽炎、扁桃体炎和鼻炎,有无口腔溃疡、口腔溃疡≥2次/年,反流性食管炎,慢性皮肤病在肾源性血尿组发生率高。2.IgA肾病患者皮肤黏膜炎症发病率很高。3.IgA肾病很可能是从自身炎症性疾病到自身免疫性疾病的大疾病谱。4.中医体质与皮肤黏膜炎症类型相关,尤其是气虚质、阳虚质与上呼吸道炎症,阴虚质与慢性胃炎,湿热质与反复或慢性皮肤炎症。5.中医体质与炎症诱因相关,尤其是气虚质、阳虚质与气候变化因素,湿热质、阴虚质与饮食因素,痰湿质与过敏因素,这些可以指导个体化预防。6.体质与环境因素的相互作用可能是IgA肾病产生的重要基础。7.不同病理类型的慢性肾炎患者皮肤黏膜炎症分布有差异。8.四种病理类型之间还有许多其他指标(包括临床和实验室指标、中医体质及中医证型)有差异。9.联合这些指标可以为下一步建立预测模型提供依据。10.如果把气虚质发展至脾肾气虚型称为先天禀赋不足造成的气虚,平和质、夹湿质发展至脾肾气虚型称为后天失养导致的气虚,无论是IgA肾病还是膜性肾病的比较中都有先天禀赋不足导致的气虚的临床病理轻于后天失养导致的气虚。
[Abstract]:Objective: 1. to compare the incidence of skin mucosal inflammation in chronic nephritis and common people 2. in view of the causal relationship between skin mucosal inflammation and IgA nephropathy in the literature. We use IgA nephropathy as a model to study the reasons for the high incidence of inflammation of skin and mucous membrane in the population of IgA nephropathy, and to explore the reasons for repeated occurrence and the reasons for the recurrence. The possible prevention and control strategy.3. compared the incidence of skin and mucous inflammation in the group of patients with different pathological types of chronic nephritis, find out the various clinical indexes of different pathological types, and make preliminary exploration for the use of clinical phenotypes to predict the type of kidney pathology. 4. in the past, the previous study found that a type of syndrome can contain a variety of physique, We further explored the methods of influencing the clinicopathological characteristics of chronic nephritis: 1. a case-control study was conducted to collect data from 85 cases of nephritic isolated microscopic hematuria and 85 cases of common people, and to compare the incidence of skin mucosal inflammation in chronic glomerulonephritis with common people in.2. epidemiology. The method of field investigation was used to collect 162 cases of skin mucosa inflammation, inflammatory causes and TCM Constitution of patients with IgA nephropathy, to study the causes of high incidence of inflammation of skin and mucous membrane in people of IgA nephropathy, to analyze the relationship between the constitution of the skin and mucous membrane, the causes of inflammation, and to explore the possible countermeasures for the prevention and treatment of.3., and collect 226 methods of epidemiological investigation. Cases of skin mucosa inflammation, clinical features, TCM Constitution and TCM syndrome types of chronic nephritis patients with pathological type of renal biopsy, compared with different pathological types of chronic nephritis in the group of patients with chronic nephritis, and find out the different clinical indexes of different pathological types and.4. research methods and investigation. In the third part, the clinical data of 104 cases of spleen and kidney qi deficiency type IgA nephropathy were collected and 102 cases of different constitution of membranous nephropathy were collected. The effects of constitution and syndrome on the renal clinicopathological effects were analyzed. Results: 1. the incidence of chronic nephritis and common people's skin and mucous membrane inflammation was compared with the kidney source. There was no difference in baseline data between the cases of sexual isolated hematuria and the control group, and the comparison of skin and mucosa inflammation showed that the incidence of inflammation in the skin and mucous membrane in the hematuria group was higher than that of the control group. The more types of inflammation were more, the more significant the two groups were. Oral ulcers, oral ulcers more than 2 times / years, chronic pharyngitis, chronic tonsillitis, chronic rhinitis, reflux esophagitis, and chronic dermatosis, there are statistically significant differences in two groups. The more episodes of acute inflammation, such as colds and oral ulcers, the more statistically significant the two groups are. The repeated or chronic inflammation of the skin and mucous membrane is in the chronic kidney The incidence of inflammatory groups is very high? What are the factors associated with the occurrence of inflammation in the skin and mucous membrane? What is the relationship with the occurrence and development of renal diseases? Investigation of 2.IgA nephropathy and related factors in 2.1162 cases of IgA nephropathy, the general analysis of 92 cases in 162 patients and 70 cases in women, with an average age of 35.9 + 12 .5 years old, the average course of disease was 42.9 + 35.5 months, among which 19 cases (11.7%) were caused by nephrotic syndrome, 25 cases (15.4%) with naked eye hematuria, 150 cases (92.6%) and 162 cases of.2.2 in 162 patients, and 162 cases of IgA nephropathy were distributed in 162 cases, 78 cases (48.1%), Qi deficiency 23 cases (14.2%), Yang deficiency syndrome cases There were three types of concurrently, 7 cases of qi depression, 7 cases of qi depression (4.3%), 15 cases of special quality (9.3%), and 6 cases of blood stasis (3.7%).2.3 IgA nephropathy in patients with recurrent or chronic inflammation of the skin and mucous membrane, of which there were 141 cases (87%), 21 cases (13%) without inflammation, chronic rhinitis, chronic pharyngitis and chronic pharyngitis. 28 cases (17.3%) of sexual tonsillitis, 68 cases of gingivitis or periodontitis, 28 cases of repeated oral ulcers (17.3%), 43 cases of recurrent upper respiratory tract infection (26.5%), 35 cases of chronic enteritis (21.6%), chronic gastritis or duodenal ulcer 31 (19.1%), skin inflammation (urticaria or acne) 71 cases (43.8%). A patient can have many kinds of inflammation and inflammation of the skin and mucous membrane. The distribution of the causes of 2-3 kinds of.2.4 inflammation in the skin and mucous membrane, we investigated the causes of repeated or chronic inflammation of the skin and mucous membrane, mainly 70 cases of climate change (43.2%), 37 cases of dietary factors (22.8%), 44 cases of insomnia (27.2%), 48 cases of fatigue (29.6%), 11 cases (6.8%) of emotional factors and 19 cases (11.7%) of allergic factors (11.7%), constitution and inflammation of Chinese medicine. Compared with the physique of traditional Chinese medicine, the types of the 9 types of inflammation were compared with the physique of traditional Chinese medicine. The incidence of gastritis or duodenal ulcers and yin deficiency is high and has statistical significance. Compared with the quality of peace and quality, the incidence of repeated or chronic skin inflammation is high, and there is a statistical significance (P0.05) the comparison between the constitution of.2.6 and the inducement of inflammation in the comparison of the physical and inflammatory inducements, we also found that the distribution of the constitution under the causes of different mucosal inflammation is also found. Differences, such as the causes of climate change induced inflammation, have a higher proportion of asthenia and yang deficiency patients, compared with the flat and phlegm and phlegm dampness. The patients with dietary factors inducing or aggravating the skin and mucous membrane inflammation are more humid and yin deficiency, compared with the flat and yang deficiency. Patients with phlegm dampness are most significant (P0.05). The incidence of skin mucosal inflammation is very high in patients with IgA nephropathy, which is related to the physique of traditional Chinese medicine. Then how is the disease in other pathological types of chronic nephritis? Can the physique be used to pretest the different pathological types of chronic glomerulonephritis? 3. different diseases The comparison of skin mucosal inflammation and clinical phenotypes in 3.1226 patients with chronic nephritis and clinical phenotypes in 226 cases, the age of 226 patients was mostly between 18 and 55 years, 133 men, 93 women, 38 (12,48) months in the course of disease, 1 (0.4%), 136 cases (60.2%), MN There were 15 cases (6.6%) in the group of IgA (IgA+MN), 61 cases (27%) in MN, 13 (5.8%) in group MCD and 226 of.3.2 in 226 patients. Among the 226 patients, there were 3 cases of lack of TCM Constitution and syndrome type, and 223 patients were analyzed statistically. The distribution of TCM syndrome type was spleen kidney qi deficiency 152 (68.2%) and spleen and kidney. There were 48 cases (21.5%) of Yang deficiency, 32 cases of water wet syndrome (14.3%), 48 cases of damp turbid syndrome (21.5%), 58 cases of damp heat syndrome (26%), 32 cases of blood stasis syndrome (14.3%). The most common in the constitution of traditional Chinese medicine were Ping and Qi (35.4%), followed by qi deficiency and substance 29 cases (26%), phlegm and wet quality cases of.3.3 skin mucosa inflammation to chronic nephritis The number of FSGS cases was less than that of pathological type, so it was not included. The results showed that chronic rhinitis, chronic pharyngitis, recurrent or chronic gingivitis / periodontitis had a statistically significant difference in the different pathological distribution of skin acne (P0.05). 22 after comparison, repeated or chronic gingivitis / periodontitis was mostly in IgA+MN, MN patients, and compared with IgAN. Statistical significance, the proportion of IgA+MN was higher than that of MCD.IgAN upper respiratory tract inflammation and skin inflammation, and compared with MN (P0.05) the comparison of clinical parameters of different pathological types of.3.4 chronic nephritis listed 20 kinds of statistically significant indexes, including age, medical history, clinical indicators, TCM Constitution and syndrome type, and further 22 comparison after comparison. It was found that IgAN age, the proportion of nephrotic syndrome, the proportion of renal function abnormalities, 24 hours urinary protein, albumin, serum creatinine and other three groups were statistically significant (P0.01), the age of MCD patients was lower than MN (P0.01), the serum IgA, C3 in group MN were lower than group IgAN, IgE was higher than that of IgAN group, and the results were statistically significant (P0.01), and in constitution and syndrome type, spleen and kidney yang The proportion of deficiency syndrome and yang deficiency was higher than that in group IgAN (P0.01), and the proportion of phlegm wet quality in IgAN was higher than that in group MN (P0.01). In this study, the distribution of TCM Constitution and syndrome type between different pathological types of nephritis was found to be different, we also found that sometimes a type of syndrome can contain a variety of body. Quality, and will it affect the clinical pathology of kidney? 4. Chinese medicine constitution, syndrome type and clinicopathological study of chronic nephritis 4.1 comparison of the clinicopathological characteristics of different constitution of spleen and kidney qi type IgA nephropathy: 4.1.1 three types of kidney pathology Katafuchi integral and clinical indexes, we have included 104 cases of spleen and kidney Qi deficiency patients, Chinese medicine body There were three types of physique, 40 cases of flat and qualitative, 19 cases of qi deficiency and 45 cases of damp heat (including damp heat and phlegm wet quality). The integral of qi deficiency glomeruli was lower than that of flat and mass. The integral of the renal blood vessel was higher than that of flat and mass. The difference was statistically significant. The integral and total score of the glomeruli were the lowest in the Qi deficiency, followed by the mass and the highest humid quality. Trends. Total cholesterol, triglycerides, creatinine and uric acid were the lowest, followed by the flat and mass, the highest tendency of the wet quality, the clinicopathological comparison of the different constitution of.4.2 membranous nephropathy compared 4.2.1 baseline and pathological comparison in 102 cases of membranous nephropathy, the main syndromes of TCM were spleen kidney qi deficiency (64.2%) and spleen kidney yang deficiency 30 cases (28.3%), lung (28.3%), lung Kidney qi deficiency in 1 cases (0.9%), Qi and yin deficiency in 2 cases (1.9%), yin and yang two deficiency 1 cases (0.9%) were not included in the comparison. No special temperament, qi stagnation and blood stasis, phlegm wet quality and damp heat are all the damp constitution, because the number of wet and damp heat in the phlegm and damp heat are all the damp constitution. There were 43 cases (42.2%), 11 cases of qi deficiency (10.8%), 14 cases of humid mass (13.7%), 24 cases of Yang deficiency (23.5%) and 6 cases of non Yang deficiency (5.9%). There were no statistical significance in the age, course of illness, and distribution of hypertension in these five constitution. There were statistical significance in the sex distribution of the patients in the five group. Middle level and mass, Yang deficiency quality is the lowest, Qi deficiency, non Yang deficiency is the second, the humid quality is the highest, the difference has statistical significance. The proportion of stage II membranous nephropathy in patients with spleen and kidney qi deficiency damp type patients is higher than that of other physical types, followed by flat and spleen kidney qi deficiency type, Qi deficiency spleen and kidney qi deficiency type is the smallest, the difference has statistical significance.4.2.2 five kinds of constitution. The results of the laboratory examination compared with the renal function, the creatinine was higher than the Qi deficiency and the Yang deficiency.24 hourly proteinuria, with the highest moisture content. The blood creatinine and the 24 hour urine protein had the lowest Qi deficiency, the level and the quality were the highest. The comparison of the Yang Deficiency clinical disease theory was not less than the non Yang deficiency. Conclusion: 1. skin sticky The incidence of membrane inflammation is higher in patients with nephritic hematuria. There are no colds, cold more than 3 times per year, chronic pharyngitis, tonsillitis and rhinitis, oral ulcers, oral ulcers more than 2 times / years, reflux esophagitis, and high incidence of chronic dermatosis in the nephritic hematuria group, with high incidence of inflammation of skin and mucous membrane in.2.IgA nephropathy patients.3.IgA Kidney disease is likely to be a major disease spectrum from its own inflammatory disease to autoimmune disease.4. constitution related to the type of inflammation of the skin and mucous membrane, especially Qi deficiency, Yang deficiency and upper respiratory tract inflammation, yin deficiency and chronic gastritis, damp heat and repeated or chronic skin inflammation, related to the cause of inflammation, especially Qi deficiency. The factors of Yang deficiency and climate change, damp heat, yin deficiency and diet, phlegm, humidity and hypersensitivity, which can guide the individualized prevention of the interaction between.6. constitution and environmental factors may be an important basis for the production of IgA nephropathy,.7. of different pathological types of chronic glomerulonephritis with different.8. four types of pathological types There are many other indicators (including clinical and laboratory indicators, TCM Constitution and TCM syndromes)..9. can combine these indicators.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R692
本文编号：2138788
[Abstract]:Objective: 1. to compare the incidence of skin mucosal inflammation in chronic nephritis and common people 2. in view of the causal relationship between skin mucosal inflammation and IgA nephropathy in the literature. We use IgA nephropathy as a model to study the reasons for the high incidence of inflammation of skin and mucous membrane in the population of IgA nephropathy, and to explore the reasons for repeated occurrence and the reasons for the recurrence. The possible prevention and control strategy.3. compared the incidence of skin and mucous inflammation in the group of patients with different pathological types of chronic nephritis, find out the various clinical indexes of different pathological types, and make preliminary exploration for the use of clinical phenotypes to predict the type of kidney pathology. 4. in the past, the previous study found that a type of syndrome can contain a variety of physique, We further explored the methods of influencing the clinicopathological characteristics of chronic nephritis: 1. a case-control study was conducted to collect data from 85 cases of nephritic isolated microscopic hematuria and 85 cases of common people, and to compare the incidence of skin mucosal inflammation in chronic glomerulonephritis with common people in.2. epidemiology. The method of field investigation was used to collect 162 cases of skin mucosa inflammation, inflammatory causes and TCM Constitution of patients with IgA nephropathy, to study the causes of high incidence of inflammation of skin and mucous membrane in people of IgA nephropathy, to analyze the relationship between the constitution of the skin and mucous membrane, the causes of inflammation, and to explore the possible countermeasures for the prevention and treatment of.3., and collect 226 methods of epidemiological investigation. Cases of skin mucosa inflammation, clinical features, TCM Constitution and TCM syndrome types of chronic nephritis patients with pathological type of renal biopsy, compared with different pathological types of chronic nephritis in the group of patients with chronic nephritis, and find out the different clinical indexes of different pathological types and.4. research methods and investigation. In the third part, the clinical data of 104 cases of spleen and kidney qi deficiency type IgA nephropathy were collected and 102 cases of different constitution of membranous nephropathy were collected. The effects of constitution and syndrome on the renal clinicopathological effects were analyzed. Results: 1. the incidence of chronic nephritis and common people's skin and mucous membrane inflammation was compared with the kidney source. There was no difference in baseline data between the cases of sexual isolated hematuria and the control group, and the comparison of skin and mucosa inflammation showed that the incidence of inflammation in the skin and mucous membrane in the hematuria group was higher than that of the control group. The more types of inflammation were more, the more significant the two groups were. Oral ulcers, oral ulcers more than 2 times / years, chronic pharyngitis, chronic tonsillitis, chronic rhinitis, reflux esophagitis, and chronic dermatosis, there are statistically significant differences in two groups. The more episodes of acute inflammation, such as colds and oral ulcers, the more statistically significant the two groups are. The repeated or chronic inflammation of the skin and mucous membrane is in the chronic kidney The incidence of inflammatory groups is very high? What are the factors associated with the occurrence of inflammation in the skin and mucous membrane? What is the relationship with the occurrence and development of renal diseases? Investigation of 2.IgA nephropathy and related factors in 2.1162 cases of IgA nephropathy, the general analysis of 92 cases in 162 patients and 70 cases in women, with an average age of 35.9 + 12 .5 years old, the average course of disease was 42.9 + 35.5 months, among which 19 cases (11.7%) were caused by nephrotic syndrome, 25 cases (15.4%) with naked eye hematuria, 150 cases (92.6%) and 162 cases of.2.2 in 162 patients, and 162 cases of IgA nephropathy were distributed in 162 cases, 78 cases (48.1%), Qi deficiency 23 cases (14.2%), Yang deficiency syndrome cases There were three types of concurrently, 7 cases of qi depression, 7 cases of qi depression (4.3%), 15 cases of special quality (9.3%), and 6 cases of blood stasis (3.7%).2.3 IgA nephropathy in patients with recurrent or chronic inflammation of the skin and mucous membrane, of which there were 141 cases (87%), 21 cases (13%) without inflammation, chronic rhinitis, chronic pharyngitis and chronic pharyngitis. 28 cases (17.3%) of sexual tonsillitis, 68 cases of gingivitis or periodontitis, 28 cases of repeated oral ulcers (17.3%), 43 cases of recurrent upper respiratory tract infection (26.5%), 35 cases of chronic enteritis (21.6%), chronic gastritis or duodenal ulcer 31 (19.1%), skin inflammation (urticaria or acne) 71 cases (43.8%). A patient can have many kinds of inflammation and inflammation of the skin and mucous membrane. The distribution of the causes of 2-3 kinds of.2.4 inflammation in the skin and mucous membrane, we investigated the causes of repeated or chronic inflammation of the skin and mucous membrane, mainly 70 cases of climate change (43.2%), 37 cases of dietary factors (22.8%), 44 cases of insomnia (27.2%), 48 cases of fatigue (29.6%), 11 cases (6.8%) of emotional factors and 19 cases (11.7%) of allergic factors (11.7%), constitution and inflammation of Chinese medicine. Compared with the physique of traditional Chinese medicine, the types of the 9 types of inflammation were compared with the physique of traditional Chinese medicine. The incidence of gastritis or duodenal ulcers and yin deficiency is high and has statistical significance. Compared with the quality of peace and quality, the incidence of repeated or chronic skin inflammation is high, and there is a statistical significance (P0.05) the comparison between the constitution of.2.6 and the inducement of inflammation in the comparison of the physical and inflammatory inducements, we also found that the distribution of the constitution under the causes of different mucosal inflammation is also found. Differences, such as the causes of climate change induced inflammation, have a higher proportion of asthenia and yang deficiency patients, compared with the flat and phlegm and phlegm dampness. The patients with dietary factors inducing or aggravating the skin and mucous membrane inflammation are more humid and yin deficiency, compared with the flat and yang deficiency. Patients with phlegm dampness are most significant (P0.05). The incidence of skin mucosal inflammation is very high in patients with IgA nephropathy, which is related to the physique of traditional Chinese medicine. Then how is the disease in other pathological types of chronic nephritis? Can the physique be used to pretest the different pathological types of chronic glomerulonephritis? 3. different diseases The comparison of skin mucosal inflammation and clinical phenotypes in 3.1226 patients with chronic nephritis and clinical phenotypes in 226 cases, the age of 226 patients was mostly between 18 and 55 years, 133 men, 93 women, 38 (12,48) months in the course of disease, 1 (0.4%), 136 cases (60.2%), MN There were 15 cases (6.6%) in the group of IgA (IgA+MN), 61 cases (27%) in MN, 13 (5.8%) in group MCD and 226 of.3.2 in 226 patients. Among the 226 patients, there were 3 cases of lack of TCM Constitution and syndrome type, and 223 patients were analyzed statistically. The distribution of TCM syndrome type was spleen kidney qi deficiency 152 (68.2%) and spleen and kidney. There were 48 cases (21.5%) of Yang deficiency, 32 cases of water wet syndrome (14.3%), 48 cases of damp turbid syndrome (21.5%), 58 cases of damp heat syndrome (26%), 32 cases of blood stasis syndrome (14.3%). The most common in the constitution of traditional Chinese medicine were Ping and Qi (35.4%), followed by qi deficiency and substance 29 cases (26%), phlegm and wet quality cases of.3.3 skin mucosa inflammation to chronic nephritis The number of FSGS cases was less than that of pathological type, so it was not included. The results showed that chronic rhinitis, chronic pharyngitis, recurrent or chronic gingivitis / periodontitis had a statistically significant difference in the different pathological distribution of skin acne (P0.05). 22 after comparison, repeated or chronic gingivitis / periodontitis was mostly in IgA+MN, MN patients, and compared with IgAN. Statistical significance, the proportion of IgA+MN was higher than that of MCD.IgAN upper respiratory tract inflammation and skin inflammation, and compared with MN (P0.05) the comparison of clinical parameters of different pathological types of.3.4 chronic nephritis listed 20 kinds of statistically significant indexes, including age, medical history, clinical indicators, TCM Constitution and syndrome type, and further 22 comparison after comparison. It was found that IgAN age, the proportion of nephrotic syndrome, the proportion of renal function abnormalities, 24 hours urinary protein, albumin, serum creatinine and other three groups were statistically significant (P0.01), the age of MCD patients was lower than MN (P0.01), the serum IgA, C3 in group MN were lower than group IgAN, IgE was higher than that of IgAN group, and the results were statistically significant (P0.01), and in constitution and syndrome type, spleen and kidney yang The proportion of deficiency syndrome and yang deficiency was higher than that in group IgAN (P0.01), and the proportion of phlegm wet quality in IgAN was higher than that in group MN (P0.01). In this study, the distribution of TCM Constitution and syndrome type between different pathological types of nephritis was found to be different, we also found that sometimes a type of syndrome can contain a variety of body. Quality, and will it affect the clinical pathology of kidney? 4. Chinese medicine constitution, syndrome type and clinicopathological study of chronic nephritis 4.1 comparison of the clinicopathological characteristics of different constitution of spleen and kidney qi type IgA nephropathy: 4.1.1 three types of kidney pathology Katafuchi integral and clinical indexes, we have included 104 cases of spleen and kidney Qi deficiency patients, Chinese medicine body There were three types of physique, 40 cases of flat and qualitative, 19 cases of qi deficiency and 45 cases of damp heat (including damp heat and phlegm wet quality). The integral of qi deficiency glomeruli was lower than that of flat and mass. The integral of the renal blood vessel was higher than that of flat and mass. The difference was statistically significant. The integral and total score of the glomeruli were the lowest in the Qi deficiency, followed by the mass and the highest humid quality. Trends. Total cholesterol, triglycerides, creatinine and uric acid were the lowest, followed by the flat and mass, the highest tendency of the wet quality, the clinicopathological comparison of the different constitution of.4.2 membranous nephropathy compared 4.2.1 baseline and pathological comparison in 102 cases of membranous nephropathy, the main syndromes of TCM were spleen kidney qi deficiency (64.2%) and spleen kidney yang deficiency 30 cases (28.3%), lung (28.3%), lung Kidney qi deficiency in 1 cases (0.9%), Qi and yin deficiency in 2 cases (1.9%), yin and yang two deficiency 1 cases (0.9%) were not included in the comparison. No special temperament, qi stagnation and blood stasis, phlegm wet quality and damp heat are all the damp constitution, because the number of wet and damp heat in the phlegm and damp heat are all the damp constitution. There were 43 cases (42.2%), 11 cases of qi deficiency (10.8%), 14 cases of humid mass (13.7%), 24 cases of Yang deficiency (23.5%) and 6 cases of non Yang deficiency (5.9%). There were no statistical significance in the age, course of illness, and distribution of hypertension in these five constitution. There were statistical significance in the sex distribution of the patients in the five group. Middle level and mass, Yang deficiency quality is the lowest, Qi deficiency, non Yang deficiency is the second, the humid quality is the highest, the difference has statistical significance. The proportion of stage II membranous nephropathy in patients with spleen and kidney qi deficiency damp type patients is higher than that of other physical types, followed by flat and spleen kidney qi deficiency type, Qi deficiency spleen and kidney qi deficiency type is the smallest, the difference has statistical significance.4.2.2 five kinds of constitution. The results of the laboratory examination compared with the renal function, the creatinine was higher than the Qi deficiency and the Yang deficiency.24 hourly proteinuria, with the highest moisture content. The blood creatinine and the 24 hour urine protein had the lowest Qi deficiency, the level and the quality were the highest. The comparison of the Yang Deficiency clinical disease theory was not less than the non Yang deficiency. Conclusion: 1. skin sticky The incidence of membrane inflammation is higher in patients with nephritic hematuria. There are no colds, cold more than 3 times per year, chronic pharyngitis, tonsillitis and rhinitis, oral ulcers, oral ulcers more than 2 times / years, reflux esophagitis, and high incidence of chronic dermatosis in the nephritic hematuria group, with high incidence of inflammation of skin and mucous membrane in.2.IgA nephropathy patients.3.IgA Kidney disease is likely to be a major disease spectrum from its own inflammatory disease to autoimmune disease.4. constitution related to the type of inflammation of the skin and mucous membrane, especially Qi deficiency, Yang deficiency and upper respiratory tract inflammation, yin deficiency and chronic gastritis, damp heat and repeated or chronic skin inflammation, related to the cause of inflammation, especially Qi deficiency. The factors of Yang deficiency and climate change, damp heat, yin deficiency and diet, phlegm, humidity and hypersensitivity, which can guide the individualized prevention of the interaction between.6. constitution and environmental factors may be an important basis for the production of IgA nephropathy,.7. of different pathological types of chronic glomerulonephritis with different.8. four types of pathological types There are many other indicators (including clinical and laboratory indicators, TCM Constitution and TCM syndromes)..9. can combine these indicators.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R692
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