Clinical pathological characteristics,traditional Chinese medicine syndromes and prognostic factors of mesangial proliferative IgA nephropathy
Objective It is to investigate the clinical pathologic characteristics,distribution regularities of traditional Chinese medicine ( TCM) syndrome and factors related to the prognosis of patients with mesangial proliferative IgA ne-phropathy ( IgAN),in order to provide reference for clinical prevention and treatment of this disease and further research.Methods A retrospective study was conducted to collect baseline data ( including demographic data,laboratory examination data,and pathological data),TCM syndrome data,and follow-up data of patients with thylakoid proliferative IgAN who were treated in inpatient department and out-patient department of Guangdong Provincial Hospital of Traditional Chinese Medicine and diagnosed with renal puncture biopsy from April 2008 to December 2023.According to the degree of thyla-koid hyperplasia,the patients were divided into mild hyperplasia group,moderate hyperplasia group and severe hyperplasia group,and the laboratory indexes of patients in the three groups were compared.According to the degree of thylakoid hy-perplasia,the patients were divided into mild hyperplasia group and moderate-severe hyperplasia group,and the TCM syn-dromes of the patients in the two groups were compared.According to the differentiation of syndromes,the patients were di-vided into 4 groups:group of lung-spleen Qi deficiency syndrome,group of Qi-Yin deficiency syndrome,group of liver-kid-ney Yin deficiency syndrome,and group of spleen-kidney Yang deficiency syndrome,and the laboratory indexes of the pa-tients in the four groups were compared.According to the patients' follow-up prognosis,they were divided into the group with endpoint events and the group without endpoint events,and the laboratory indexes and TCM syndromes of the patients in the two groups were compared.The patients' cumulative survival rate,median cumulative survival time were analyzed by Kaplan-Meier analysis,and the factors related to the prognosis of mesangial proliferative IgAN were analyzed by Cox regres-sion analysis.Results A total of 112 patients were included.The serum levels of LDL-C and IgA of patients in the mild hy-perplasia group were significantly lower than those in the moderate hyperplasia group and severe hyperplasia group ( all P<0.05),while the serum levels of albumin was significantly higher than those in the moderate hyperplasia group and severe hyperplasia group (both P<0.05),and the level of hemoglobin was significantly higher than that in the moderate hyper-plasia group (P<0.05);the proportions of patients with syndromes of lung-spleen Qi deficiency,water-dampness,and poor sleep in the mild hyperplasia group were significantly higher than those in the moderate and severe hyperplasia group (all P<0.05),while the proportions of patients with spleen-kidney Yang deficiency syndrome,bitter taste,soreness and weakness of waist and knees,and foamy urine were significantly lower than those of the moderate and severe hyperplasia group (all P<0.05).There were significant differences in eGFR,blood creatinine,blood urea nitrogen,blood uric acid,serum albumin,hemoglobin,and serum IgA among patients with different TCM syndromes (all P<0.05),in which eGFR of patients in the lung-spleen-Qi deficiency syndrome group was significantly higher than that of the other three groups ( all P<0.05),while blood creatinine was significantly lower than that in the liver-kidney Yin deficiency syndrome group and spleen-kidney Yang deficiency syndrome group (all P<0.05),blood urea nitrogen was significantly lower than those in the Qi-Yin deficiency group and spleen-kidney Yang deficiency group (both P<0.05),blood uric acid and serum IgA were significantly lower than those in the spleen-kidney Yang deficiency group (all P<0.05),serum albumin was significantly higher than those in the liver-kidney Yin deficiency group and spleen-kidney Yang deficiency group (both P<0.05),and hemoglobin was significantly higher than that in the spleen-kidney Yang deficiency group (P<0.05).The levels of blood urea nitrogen,LDL-C,fasting blood glucose,24-h urine protein quantification,serum IgA of patients in the group with endpoint events were significantly higher,while the proportions of patients with spleen-kidney Yang-deficiency syndrome,poor appetite,poor sleep,nocturia,foamy urine,and cold feeling were significantly higher than those in the group without endpoint event (all P<0.05),the eGFR,serum albumin,hemoglobin and the proportions of patients with spleen-Qi defi-ciency symptoms were significantly lower than those in the group without endpoint event (all P<0.05).Kaplan-Meier sur-vival curve suggested that patients with severe thylakoid hyperplasia and spleen-kidney Yang-deficiency syndrome reached the endpoint event more faster;Cox regression analysis suggested that blood creatinine and blood urea nitrogen were inde-pendent risk factors for the occurrence of the composite endpoint events,and serum albumin and hemoglobin were protective factors for the occurrence of the endpoint events.Conclusion Serum IgA,LDL-C,serum albumin,and hemoglobin are sig-nificant influencing factors for both mesangial proliferation and prognosis.With the prolongation of the disease course,the TCM syndromes in patients with thylakoid proliferative IgAN evolved from lung spleen-qi deficiency syndrome→Qi-Yin de-ficiency syndrome/liver-kidney Yin deficiency syndrome → spleen-kidney Yang deficiency syndrome,and to a certain ex-tent,it reflected the process of progressive exacerbation of the clinical symptoms,laboratory test indexes,and pathology.
mesangial proliferative IgA nephropathyclinical pathological characteristicstraditional Chinese medicine syndromeprognosis
万方数据
维普
