首页|基于"肾络癥瘕"探讨800例过敏性紫癜性肾炎儿童肾脏微观血瘀证与肾脏病理分级及相关理化指标的关系

基于"肾络癥瘕"探讨800例过敏性紫癜性肾炎儿童肾脏微观血瘀证与肾脏病理分级及相关理化指标的关系

扫码查看
原文链接
  • 国家科技期刊平台
  • NETL
  • NSTL
  • 万方数据
目的 探讨过敏性紫癜性肾炎(HSPN)患儿的肾脏微观血瘀证与肾脏病理分级及相关理化指标的关系。方法 回顾性分析河南中医药大学第一附属医院800例HSPN患儿的病历资料，对其实验室指标(血常规、尿常规、凝血六项、肝功能)及肾脏病理指标进行规范化梳理，根据肾脏病理微观病变指标判断肾脏血瘀证严重程度，将肾脏微观血瘀证分为脉络不和、死血凝着和肾内癥积3个类型。采用Spearman等级相关性、二元Logistic回归分析等方法分析肾脏微观血瘀证类型及肾内癥积型与实验室指标、肾脏病理指标的相关性。结果 ①不同中医证候下的肾脏微观血瘀证类型分布差异无统计学意义。②肾脏微观血瘀证不同类型的HSPN患儿的白蛋白、纤维蛋白原的含量及分级分布差异有统计学意义(均P＜0。05)。③纤维蛋白原与肾内癥积形成的接受者操作特性(ROC)曲线下面积最大为0。594(95％CI为0。540～0。633，P＜0。001);敏感度0。447，特异度0。725，约登指数0。172，对应切点的ROC曲线上的最佳临界值为3。755 g/L。④纤维蛋白原含量及肾脏病理国际小儿肾脏病研究组(ISKDC)分级、Bohle A分级均与肾内癥积积分呈正相关性(r=0。176，r=0。315，r=0。656;均P＜0。001)。⑤纤维蛋白原含量及肾脏病理ISKDC分级、Bohle A分级也与肾脏微观血瘀证类型均呈正相关(r=0。157，r=0。377，r=0。429;均P＜0。001)。结论 肾脏微观血瘀证类型既能反映肾脏血瘀证的轻重，也能反映肾脏病理的轻重及远期预后。白蛋白指标和尿蛋白分级可反映肾脏微观血瘀证早期病变(脉络不和型);纤维蛋白原含量随肾脏微观血瘀证的加重而增加，主要反映其后期病变及肾内癥积指标的形成和强弱，可作为辅助判断HSPN患儿肾脏病理中出现不可逆病变的一项实验室指标。
The relationship between microscopic pattern of blood stasis and renal pathological grade and related physical and chemical indexes in 800 children with Henoch-Sch?nlein purpura nephritis based on"zhengjia in the kidney collateral"
Objective We aimed to investigate the relationship between microscopic pattern of blood stasis and renal pathological grade and related physical and chemical indexes in children with Henoch-Schönlein purpura nephritis(HSPN).Methods We conducted a retrospective analysis of 800 HSPN children from the medical records of the First Affiliated Hospital of Henan University of Chinese Medicine.Laboratory indicators(blood routine test,urine routine test,coagulation test,liver function)and renal pathological indicators of them were collected.According to the severity of renal pathological microscopic lesions,the microscopic pattern of blood stasis was divided into three types,including choroidal discord,dead blood coagulation and intracarenal disease accumulation.The classification of renal microscopic pattern of blood stasis and the correlation between laboratory indexes and renal pathological index were analyzed by Spearman grade correlation and binary Logistic regression analysis.Results(ⅰ)There was no statistical difference of the distribution of the renal microscopic pattern of blood stasis in the different traditional Chinese medicine patterns.(ⅱ)There were significant differences in the contents or the grade of albumin and fibrinogen in the HSPN children with different microscopic pattern of blood stasis(all P＜0.05).(ⅲ)The maximum area under the receiver operating characteristic(ROC)curve between fibrinogen and intracarenal disease accumulation was 0.594(95％CI from 0.540 to 0.633,P＜0.001);sensitivity was 0.447,specificity was 0.725;the best threshold on the ROC curve of 0.172 was 3.755 g/L.(ⅳ)There were positive correlations between the content of fibrinogen,ISKDC grade and Bohle A grade respectively with the scores of intracarenal disease accumulation type(r=0.176,r=0.315,r=0.656;all P＜0.001).(ⅴ)There were positive correlations between the content of fibrinogen,ISKDC grade and Bohle A grade respectively with the renal microscopic pattern of blood stasis(r=0.157,r=0.377,r=0.429;all P＜0.001).Conclusion The microscopic renal pattern of blood stasis can not only reflect the severity of renal blood stasis,but also reflect the severity and long-term prognosis of renal diseases.Albumin and urinary protein grade can reflect the early stage of the microscopic renal pattern of the blood stasis(choroidal discord).The content of fibrinogen increases with the aggravation of renal microscopic pattern of blood stasis,reflecting the end-stage of HSPN,which has the correlation with the formation and severity of related indexes.Fibrinogen can be used as a laboratory indicator to assist in the diagnosis of irreversible lesionsin the renal pathology of HSPN children.

Henoch-Schönlein purpura nephritispathological gradecoagulation indexblood stasisfibrinogen

高敏、丁樱、吴瑞红、任献青、徐炎、韩姗姗、代彦林、黄岩杰、杨晓青、徐闪闪

展开 >

河南中医药大学儿科医学院 郑州 450046

河南中医药大学第一附属医院儿科医院

河南中医药大学第一附属医院信息科

过敏性紫癜性肾炎 病理分级 凝血指标 血瘀 纤维蛋白原

国家自然科学基金青年科学基金项目国家自然科学基金青年科学基金项目国医大师工作室建设项目河南省博士后基金河南省特色骨干学科中医学第二批学科建设项目河南省中医学"双一流"创建科学研究专项

8230531182305310国中医药人教发[2022]245号HN2022096STG-ZYX05-202140HSRP-DFCTCM-2023-8-10

2024

10.3969/j.issn.1006-2157.2024.01.014

北京中医药大学学报
北京中医药大学

北京中医药大学学报

CSTPCD北大核心
影响因子：1.568
ISSN：1006-2157
年,卷(期)：2024.47(1)
  • 18