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纸质出版日期:2016
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夏金金, 汪涛, 刘旭生. 不同体质、证型膜性肾病患者临床病理相关性分析[J]. 中国实验方剂学杂志, 2016,22(17):130-135.
XIA Jin-jin, WANG Tao, LIU Xu-sheng. Clinic-pathology Correlation in Different Tractional Chinese Medicine Constitutions and Syndrome Patterns in Patients with Membranous Nephropathy[J]. Chinese journal of experimental traditional medical formulae, 2016, 22(17): 130-135.
夏金金, 汪涛, 刘旭生. 不同体质、证型膜性肾病患者临床病理相关性分析[J]. 中国实验方剂学杂志, 2016,22(17):130-135. DOI: 10.13422/j.cnki.syfjx.2016170130.
XIA Jin-jin, WANG Tao, LIU Xu-sheng. Clinic-pathology Correlation in Different Tractional Chinese Medicine Constitutions and Syndrome Patterns in Patients with Membranous Nephropathy[J]. Chinese journal of experimental traditional medical formulae, 2016, 22(17): 130-135. DOI: 10.13422/j.cnki.syfjx.2016170130.
目的:探讨不同体质在膜性肾病不同证型之间的病理差异以及临床病理的相关性。方法:采用横断面调查的方法,根据102例患者的临床表现由中医师进行辨证分型,再由患者填写“中医体质分类判定表”确立体质,收集实验室指标、肾脏病理等资料,分析102例肾病患者的中医体质、证型与病理资料和临床指标的关系。结果:102例患者共5种证型,其中肺肾气虚、气阴两虚和阴阳两虚例数(共4例)较少故未纳入比较,患者中未见气郁质、禀赋质和瘀血质。肾脏病理分期采用Glassock标准,Ⅱ期膜性肾病中气虚质脾肾气虚型占比最低,其次是平和质,夹湿体质(包含痰湿质和湿热质)脾肾气虚型最多(P<0.05)。临床指标方面:夹湿体质脾肾气虚型患者的体质指数(BMI)显著高于平和质与气虚质脾肾气虚型患者(P<0.01)。夹湿体质脾肾气虚型患者血肌酐最高,其次是平和质脾肾气虚型,气虚质脾肾气虚型血肌酐最低(P<0.05);阳虚质脾肾阳虚型血肌酐明显低于夹湿质脾肾气虚型患者(P<0.05)。平和质脾肾气虚型甘油三酯显著高于阳虚质脾肾阳虚型(P<0.01)。夹湿体质脾肾气虚型高密度脂蛋白(HDL-C)明显低于阳虚质脾肾阳虚型(P<0.05)和平和质脾肾气虚型患者(P<0.05)。24 h尿蛋白检测显示夹湿体质脾肾气虚型患者最高,其次是平和质脾肾气虚型,气虚质脾肾气虚型和阳虚质脾肾阳虚型最低(P<0.05)。免疫指标:阳虚质脾肾阳虚型免疫球蛋白G(IgG)高于夹湿体质脾肾气虚型(P<0.05),血沉(ESR)显著高于平和质脾肾气虚型(P<0.01)。结论:体质与证型差异较大的患者临床病理结果相对较重,提示膜性肾病患者的体质、证型与病理积分及临床指标显著相关,即使辨证属证型较重的患者(脾肾阳虚型),因体质不同,临床和病理表现也呈现出差异性,因此同一证型、不同体质患者的预防和治疗应该有所差异。中医体质辨识结合临床辨证对膜性肾脏病理的预测,诊断和治疗上有一定的参考价值。
Objective: To investigate the pathological and clinical discrepancy and clinic-pathology correlation of different traditional Chinese medicine (TCM) constitutions and different TCM syndrome patterns among patients with membranous nephropathy. Method: A cross-sectional study was used to collect the clinical data and analyze the correlation among TCM syndrome patterns
constitutions
pathological stages and laboratory results of 102 patients. TCM patterns were determined by a Chinese medicine physician according to the manifestation. Patients filled out the 'TCM Constitution Classification Table' to determine the constitutions. Result: There were five TCM syndrome patterns among 102 patients with membranous nephropathy. Syndromes of Qi deficiency of lung and kidney
Qi-Yin deficiency and Yin-Yang deficiency were excluded for comparison due to the small number of cases (only 4 patients). TCM constitutions of Qi stagnation and blood stasis
endowment quality were not found in the patients. Glassock stage was used to determine the renal pathology severity. The percentage of Qi deficiency constitution was lower than that of normal constitution
and the percentage of spleen and kidney Qi deficiency type dampness constitution (including dampness-heat constitution and dampness-phlegm constitution) was highest at membranous nephropathy stage Ⅱ (P<0.05). In clinical indexes:body mass index (BMI) of spleen and kidney deficiency type dampness constitution was higher than that of other constitutions (P<0.01). Serum creatinine of spleen and kidney Qi deficiency type dampness constitution was higher than that of normal constitution
and it was lowest in spleen and kidney Qi deficiency type Qi deficiency constitution (P<0.05). Serum creatinine of spleen and kidney Yang deficiency type Yang deficiency constitution was significantly lower than that of spleen and kidney Qi deficiency type dampness constitution (P<0.05). Triglyceride of spleen and kidney Qi deficiency type dampness constitution was significantly higher than that of spleen and kidney Yang deficiency type Yang deficiency constitution (P<0.01). High density lipoproteins (HDL-C) of spleen and kidney Qi deficiency type dampness constitution was significantly lower than that of spleen and kidney Yang deficiency type Yang deficiency constitution and spleen and kidney Qi deficiency type normal constitution (P<0.05). 24 h urine protein was highest in spleen and kidney Qi deficiency type dampness constitution
followed by spleen and kidney Qi deficiency type normal constitution
spleen and kidney Qi deficiency type Qi deficiency constitution
and spleen and kidney Yang deficiency type Yang deficiency constitution (P<0.05). In immune indexes:Immunoglobulin G (IgG) of Yang deficiency constitution was higher than that of dampness constitution (P<0.05)
and erythrocyte sedimentation rate (ESR) of Yang deficiency constitution was significantly higher than that of normal constitution (P<0.01). Conclusion: Patients with disparities of TCM constitutions and syndrome patterns may have a severe clinic-pathology results
while patients with similar TCM constitutions and syndrome patterns may have an opposite result. These suggested that TCM constitutions and syndrome patterns were correlated with clinical indicators. Different constitutions may present with different clinic-pathology results even in the same TCM syndrome pattern. Therefore
prevention and treatment of different constitutions should be discriminatory even in the same TCM syndrome pattern. The combination of TCM constitution and syndrome pattern may take a role in pathology prediction
diagnosis and treatment for membranous nephropathy.
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