IgA肾病尿液足细胞与牛津病理分型及中医证型的病例对照研究

发布时间：2018-02-26 04:30

本文关键词： IgAN 足细胞牛津病理分型中医证型　出处：《浙江中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过研究IgAN尿液足细胞与牛津病理分型及中医证型的相关性,优化IgAN的中医辨证体系,为正确认识和评价IgAN的疾病状态、判断病情进展及改善预后提供客观依据。方法选取在杭州市中医院经肾活检提示为原发性的IgAN患者共120例,其中足细胞阳性60例,足细胞阴性60例。对所有IgAN研究病例按照统一设计的表格进行相关临床资料、实验室指标、中医证型的采集与整理,应用SPSS17.0软件对数据进行统计学处理,分析尿液足细胞与IgAN牛津病理分型的关系,分析不同中医证型IgAN与尿液足细胞的关系,分析IgAN不同中医证型与牛津病理分型的关系,最后整合分析尿液足细胞数、牛津病理分型和中医证型三者之间的相关性。结果1、将入组患者分成尿足细胞阳性组与足细胞阴性两组,比较两组的临床、实验室、牛津病理指标发现足细胞阳性组24小时蛋白定量、血肌酐、血尿酸、镜下红细胞百分比高于足细胞阴性组,血清白蛋白、估算肾小球滤过率、内生肌酐清除率、尿渗透压低于足细胞阴性组,足细胞阳性组肾功能不全发生率高于足细胞阴性组,差异具有统计学意义(P0.05)。同时,足细胞阳性组中毛细血管内皮细胞增生(E)、节段粘连或硬化(S)、间质纤维化或肾小管萎缩(T)百分比高于足细胞阴性组,差异具有统计学意义(P0.05)。2、Logistic回归结果显示尿足细胞、平均动脉压与发生肾功能不全正相关,接近显著性统计学意义(P=0.071,P=0.053)。3、对足细胞两组中医证型进行比较发现,足细胞阳性组总风湿证型(包括风湿一联证、风湿二联证、风湿三联证、风湿四联证)所占比例最高,但证型单独分析后发现足细胞阳性组风湿瘀痹证最多见,风湿瘀痹证风湿证肾虚瘀痹证,足细胞阴组则以肾虚瘀痹证最多见,肾虚瘀痹证肾虚证风湿瘀痹证。足细胞阳性组总风湿证的发生率高于足细胞阴性组,差异具有统计学意义(P0.05)。4、将入组患者分为风湿证组和非风湿证组两组,发现风湿证组中毛细血管内皮细胞增生(E)、节段粘连或硬化(S)、间质纤维化或肾小管萎缩(T)、动脉积分(A)百分比高于非风湿证组,差异有统计学意义(P0.05)。结论尿足细胞阳性IgAN患者的肾损伤及肾脏病理改变更重,尿足细胞阳性与IgAN风湿内扰证密切相关,风湿证IgAN患者的肾脏病理改变更重。
[Abstract]:Objective to optimize the TCM syndrome differentiation system of IgAN by studying the correlation between urinary podocytes of IgAN and Oxford pathological classification and TCM syndromes, so as to correctly understand and evaluate the disease status of IgAN. Methods 120 patients with primary IgAN were selected by renal biopsy in Hangzhou traditional Chinese Medicine Hospital, 60 of them were podocyte positive. 60 cases of podocyte negative. According to the unified design of the table, all cases of IgAN were collected and sorted according to the unified design of clinical data, laboratory indicators, TCM syndromes, and the data were statistically processed by SPSS17.0 software. The relationship between urinary podocyte and IgAN Oxford pathological classification, the relationship between different TCM syndromes IgAN and urinary podocyte, and the relationship between different IgAN TCM syndromes and Oxford pathological typing were analyzed. Finally, the number of urinary podocytes was analyzed. Results 1. The patients were divided into two groups: positive urine podocyte group and podocyte negative group. Oxford pathological markers showed that 24 hours protein quantification, serum creatinine, uric acid, erythrocyte percentage under microscope were higher in podocyte positive group than in podocyte negative group, serum albumin, estimated glomerular filtration rate, endogenous creatinine clearance rate. The incidence of renal insufficiency in podocyte positive group was higher than that in podocyte negative group (P 0.05). In podocyte positive group, the percentage of capillary endothelial cell proliferation, segmental adhesion or sclerosis, interstitial fibrosis or renal tubular atrophy was higher than that of podocyte negative group, and the difference was statistically significant (P 0.05). Logistic regression analysis showed that urinary podocyte. The mean arterial pressure was positively correlated with renal insufficiency, which was close to significant statistical significance (P < 0.071). The TCM syndrome types of podocyte were compared between the two groups. The total rheumatism syndrome types (including rheumatism combined syndrome, rheumatism combined syndrome, rheumatism triple syndrome) were found in podocyte positive group, and there were three syndromes in podocyte positive group, including rheumatism syndrome, rheumatism syndrome and rheumatism syndrome. The proportion of rheumatism combined syndrome was the highest, but the syndrome type was found to be the most common in podocyte positive group, rheumatic stasis syndrome, rheumatism syndrome, kidney deficiency syndrome and arthralgia syndrome in podocyte yin group, but the syndrome of kidney deficiency and stasis arthralgia was the most common syndrome in podocyte positive group. The incidence of total rheumatism in podocyte positive group was higher than that in podocyte negative group. It was found that the percentage of capillary endothelial cell proliferation, segmental adhesion or sclerosing, interstitial fibrosis or renal tubule atrophy in rheumatic syndrome group was higher than that in non-rheumatic syndrome group. Conclusion the renal injury and renal pathological changes of IgAN patients with positive uropoda cells are more serious. The positive of urinary podocytes is closely related to the internal disturbance of IgAN rheumatism, and the renal pathological changes of IgAN patients with rheumatic syndrome are more serious.
【学位授予单位】：浙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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