Comparative Study In TCM Syndrome Types And Clinical Pathological Changes Of IgA Nephropathy In Different Areas

ObjectiveThe clinical characteristics of IgAN are associated with region, race, etc. China is a large country with obvious regional characteristics. There is no research about TCM syndrome types, clinical indicators, pathological change characteristic of IgAN patients in different areas, so the objective of this research is to study the characteristics of TCM syndrome types, clinical indicators, renal pathological changes of regional IgAN among different regions in Southern and Northern parts of China, by comparising features of TCM syndrome types, clinical indicators, renal pathological changes of regional IgAN in different regions (Guangzhou/Xi’an). The analysis is based on clinical manifestation and physicochemical index in order to indicate influences of regions on clinical characteristics of IgAN. The generality and difference of the features need to be understood to provide evidence on treatment and prognosis of IgAN.MethodologyRetrospective review methods have been used to collect data of patients in nephropathy department of Shanxi Hospital of traditional Chinese medicine and Guangdong Hospital of Traditional Chinese Medical who have been identified as patients with primary IgAN by renal biopsy diagnosis from January 2010 to December 2014. Background information, Syndrome differentiation of TCM, western medicine diagnosis and physicochemical examination results, renal biopsy pathology report have been well collected, and the models of syndrome type of TCM has been built and databases of clinical and pathological parameters have been constructed. Statistical analysis is used to compare characteristics of TCM Syndrome Types、clinical indicators、renal pathological changes of regional IgAN among different regions in order to find internal patterns and correlations.Results1. General Information:The male-female ratio is 1:1.25 of IgAN patients’group in Guangzhou, and the ratio is 1.07:1 of IgAN patients’ group in Xi’an. The peak age of both groups ranges from 19 to 45 years old.2. Clinical data:The incidence of IgAN is often accompanied by mucous membrane infection, of which the majority is upper respiratory tract infection, as 22.1%. The upper respiratory tract infection and biliary infection rate of Guangzhou group is less than Xi’an group,while urinary tract infection and gastrointestinal infection ratio is more than Xi’an group.The main starting clinical manifestation of IgA nephropathy, in turn, is asymptomatic abnormal urine test, edema, macroscopic haematuria, high blood pressure, which asymptomatic abnormal urine test accounts for most, at the ratio of 36.7%. The main form of IgAN to be found is abnormal urine test. Macroscopic hematuria in the group of Guangzhou takes a higher proportion than Xi’an. And edema, high blood pressure as starting clinical manifestations in Xi’an group may be more.390 patients were diagnosed with high blood pressure on admission, at the ratio of 24.4%. Hypertension condition of two groups was compared, which occurred more frequently in Xi’an group than Guangzhou group (26.1% vs.22.5%). Difference in the serum creatinine concentrations, glomerular filtration rate, serum uric acid, C3, blood lipids, urine red blood cell count level between the two groups were statistically significant(P<0.05).Serum creatinine concentrations, serum uric acid and blood cholesterol account for a higher level in Guangzhou group than that in Xi’an, while glomerular filtration rate, triglycerides and urine red blood cell count level account for a lower level.3. The Results on clinical classification:For both groups, major clinical classification are chronic glomerulonephritis, asymptomatic proteinuria with or without microscopic hematuria, proteinuria or nephrotic syndrome, which occupy 90.20% in total 390 cases of patients with IgAN. Patients with repeated attacks macroscopic haematuria or/and asymptomatic proteinuria with or without microscopic hematuria in Guangzhou group account more than that in Xi’an group, while patients with chronic nephritis or/and malignant hypertension account less, and plenty proteinuria or nephrotic syndrome, and accelerated nephritis showed similar rates in both groups.4. The results on TCM syndrome patterns:The major clinical syndromes are spleen kidney deficiency and qi yin deficiency, which occupy 90.50% in total 390 IgAN cases. Patients with dampness-heat syndrome in lower Jiao were rare in Xi’an group, while it accounts for a higher proportion in Guangzhou group. The number of patients with spleen kidney yang deficiency in Xi’an group is much more than those in Guangzhou group, and subordinate syndrome in both groups showed dramatic difference (P<0.05). patients with dampness or/and dampness-heat syndrome account for a higher proportion in Guangzhou group, while patients with wet muddy account for a lower proportion, and patients with blood stasis syndrome take the similar ratio. There is correlation between TCM syndrome patterns and clinical classification. The condition of spleen and kidney Yang deficiency type is more serious, chronic nephritis, malignant hypertension and the accelerated nephritis type take higher ratio.5. The Results on pathologic type:The major pathologic type of IgAN are mild mesangial proliferation、focal hyperplasia and sclerosis focal hyperplasia, which took 89.40% in total 390 cases. The percentage of patients with focal hyperplasia and sclerosis, diffuse hyperplasia and sclerosis in Guangzhou group is much higher than that in Xi’an group, while percentage of patients with mild mesangial proliferation、focal hyperplasia、diffuse endocapillary proliferation in the Guangzhou group is lower than in the Xi ’an group, which indicated that the pathological type is relatively more serious in Guangzhou group. Comparison on pathological type between the two groups showed significant statistic difference (P<0.05). Dampness, dampness-heat, blood stasis and damp turbidity showed correlation with pathologic type. Patients with diffuse hyperplasia and sclerosis had higher rates of hypertension. The serum creatinine level of diffuse crescent type and diffuse hyperplasia sclerosis type is the highest, followed by focal hyperplasia sclerosis type, and other pathological types’serum creatinine level is low.6.The results on Lee classification:Grade Ⅲ accounts for the most i n Guangzhou group, followed by grade Ⅳ and grade Ⅴ, each accounts for 62.3 %,17.3%,62.3%;Grade Ⅱ accounts for the most in Xi’an group, followed by gra de Ⅲ and grade Ⅳ, in percentage of 39.2%,35.7%,17.6%;this shows that th e average degree of Guangzhou group is higher than that of Xi’an group. Cl inical classification is significantly associated with Lee grading(P<0.0 5), the severity of pathological lesion of all pathologic types is strongl y associated with the level of Lee Classification, The sequence of patholo gic types, according to Lee Classification, from the highest to the lowest, is mild mesangial proliferation type, focal proliferative, focal Sclerosis type, diffuse endocapillary proliferative type, diffuse sclerosis type. The study shows that the number of patients with kidney-Yangdeficiency of bot h groups, which are mainly classified as grade Ⅱ, Ⅲ and Ⅳ by Lee Classif ication, is obviously much larger than that of the other TCM syndromes.7. The results on Katafuchi integral:The total Katafuchi points of Guangzhou group was higher than that of Xi’an group (9.7±4.7VS 7.5±4.44) by comparasion between the two groups (p< 0.05). The glomerulus integral and tubular interstitial integral of Guangzhou group was obviously higher than that of Xi’an group, while blood vessels integral between the two groups had no obvious difference (P>0.05). The glomerulus integral and total Katafuchi integral of the spleen and kidney Yang deficiency syndrome is significantly higher than other syndromes. There was no correlation between TCM syndrome type and tubular interstitial or/and blood vessel (P<0.05). There were dramatic differences between clinical classification and tubular interstitial or blood vessels integral. Tubular interstitial integral of malignant hypertension type was significantly higher than other groups, blood vessels integral of malignant hypertension was the highest, followed by the chronic glomerulonephritis type.8. The results on Immune fluorescence:IgA+C3、IgA+IgM+C3 took the majority in Guangzhou group, each accounted for 45.5%,38.2%, followed by IgA, accounted for 8.9%. IgA+IgM+C3、IgA+IgG+IgM+C3 took the majority in Xi’an group, each accounted for 57.3%、31.7%,, followed by IgA+IgM, accounted for 7.5%, sigle IgA accounted for 0.5%. The immune fluorescence deposition sites within the two groups were dominated by mesangial deposition of lumps, the rest deposit in the mesangial area and capillary wall, IgA immune fluorescence intensity of both two groups were dominated by(3+), Xi’an group(4+)took a higher proportion than Guangzhou group(6.5%vs1.0%). The immune fluorescence intensity of FRA of two groups were mainly (-), each accounted for 99.0% and 75.4%, there were 24.6% of patients in Xi’an group whose immune fluorescence intensity of FRA was 1+.Conclusion1. The incidence rate of IgAN in male and female from different regions (Guangzhou/Xi’an) is different. The disease is most common in young and middle-aged.2. This disease does not have apparent inducement. The main form of the disease to be found is asymptomatic abnormal urine, early health examination is important for diagnosis and treatment to the disease. IgAN is often accompanied by mucosal infection, of which the majority is upper respiratory tract infection. Upper respiratory tract infection and biliary tract infection are common in Xi’an,while urinary tract infection and gastrointestinal infection are common in Guangzhou.3. Serum creatinine and serum uric acid level of patients with IgAN in Guangzhou is higher than that in Xi’an, considered that the pathological type of cases choossed was serious. There are obvious differences in the levels of blood lipids between the two groups. Xi’an area has higher triglyceride levels while Guangzhou area has higher total cholesterol, considered that it associated With dual diet, living habits, physical fitness, obesity and other factors in different areas.4. In clinical, spleen kidney qi deficiency and qi yin deficiency syndrome are the major syndromes, dampness heat syndrome in lower Jiao is rare in the Xi’an area, but the proportion of spleen and kidney Yang deficiency was significantly higher than that in Guangzhou area. The condition of patients with spleen kidney qi deficiency type is relatively light, and the condition of spleen kidney yang deficiency in patients is severe. The main treatment of IgAN is invigorating spleen and kidney, supplementing qi and nourishing Yin, which better to focus on eliminating dampness and heat in Guangzhou area and to warm kidney yang in Xi’an area at the same time.5. Considering that there were differences in Pathological type and Lee hierarchical levels between two groups due to the choice of cases, renal biopsy puncture standard and timing. Lee grade of Spleen Kidney Yang deficiency type are higher than that of other types. It showed obvious consistency between pathological damage of various pathological types and Lee classification, which prompts people with IgAN to do renal biopsy as early as possible,so as to early diagnosis and early treatment.6. Katafuchi integral of two groups is different:Total Katafuchi integral, glomerular integral, tubular interstitial of Guangzhou group is significantly higher than that of Xi’an group, blood vessels integral of two groups shows indifference. This research shows that TCM syndrome types, clinical classification and glomerular integral has significant correlation. Glomerular integral of spleen and kidney Yang deficiency syndrome was obviously higher than that of other syndromes. Clinical classification and tubular interstitial, blood vessels integral has significant correlation, tubular interstitial and blood vessels integral of malignant hypertension type were significantly higher than other type. There was no relevance between TCM syndrome type and sclerosis, section stiffness ratio.7. There were differences in immunofluorescence composition, strength in IgAN patients in two areas, whether related to factors such as the geography, it bases on further exploration.8. The research had showed that obvious regional characteristics exist in TCM syndrome types and clinical pathologic change of primary IgAN patients from different areas (Guangzhou/Xi’an). Different regions have great difference in climate characteristics, risk factors, human group’s physique and lifestyle, which are significantly related with the onset of IgAN.