Prognostic Risk Factors Related To Progression Of IgA Nephropathy To ESRD Based On TCM Syndrome Elements

Objective: In this study,Meta-analysis and the clinical data of IgAN patients can summarize the relevant prognostic risk factors for the progression of IgA nephropathy to ESRD based on TCM syndrome,and evaluate the impact of TCM treatment on the prognosis of IgA nephropathy,in order to provide more scientific basis for the clinical diagnosis and treatment of IgAN.Methods:The present study was conducted in three parts.Part I of the Meta-analysis,To explore the influence of related factors in the search of domestic and foreign literature on the progression of IgA nephropathy to ESRD;The second part was a retrospective analysis based on real-world research methods: collecting 668 IgAN patients in the first Affiliated Hospital in the first center of the Second University of Jilin University from January 2012 to October 2022,Collect and sort out data including basic demographic information,clinical physical and chemical examination,renal pathology information,TCM syndrome differentiation and TCM four-diagnosis information,Group according to whether the endpoint event has occurred or not,Both baseline data and followed up of blood creatinine above baseline,percent decrease of e GFR from baseline,CKD progression by at least one stage,progression to end-stage renal disease or dialysis,death.On the basis of descriptive statistics,Cox proportional risk regression model was used to screen risk factors in traditional Chinese and Western medicine,and the Kaplan-Meier survival curve was used to summarize the prognostic factors associated with the progression of IgA nephropathy to ESRD.The third part evaluated the impact of TCM on the prognosis of IgA nephropathy:295 patients with IgA nephropathy were included,and the included cases were divided into TCM cohort and Western medicine cohort according to different treatment methods,the course of TCM treatment and the endpoint of events were observed,and the efficacy of TCM treatment was evaluated.Results:In the first part of Meta analysis,through the collation of the included literature,three articles reported the HR and 95% confidence interval of age of IgA nephropathy to ESRD;three articles reported the progression of hematuria and IgA nephropathy;three articles reported the results of T1-T2 score in MEST score;and four articles reported the data of blood uric acid level and progression of IgA nephropathy.HR and 95% Cl for the endpoint events of these factors were1.06(1.02-1.11),1.69(0.99-2.89),2.88(1.46-5.71),1.47(1.14-1.89).Part Ⅱ retrospective analysis: 295 patients,152 in traditional Chinese and Western medicine cohort and 143 in TCM cohort.167(56.60%)men with disease duration3.84(2.46-7.57)years,age 38.0(29.0-49.0)years and follow-up 3.13(1.90-6.45)years.Through the descriptive statistics of 143 patients in the TCM cohort,it was found that the highest proportion was lung temper deficiency(49.65%),followed by spleen and kidney Yang deficiency(20.54%),qi and Yin deficiency(20.28%),liver and kidney Yin deficiency(7.69%),low focal damp heat(3.50%),and exogenous wind and heat(2.80%).In terms of concurrent syndrome,the descending order was dampness(37.06%),phlegm(21.68%),water(21.43%),blood stasis(18.18%),liver depression(9.79%),turbidity(2.80%),and cold dampness(2.80%).In the endpoint event group and no-end event group,the endpoint event group was significantly higher than the event group,and there was no significant difference between the remaining groups(P <0.001);the proportion of wet syndrome in TCM was higher in the endpoint event group than in the no-end event group(P=0.044 <0.05).After univariate analysis by Cox regression and multivariate analysis,seven variables including age,therapy,gender,BUN,24 h,urinary protein,T score,and T2 score were found as independent risk factors for the occurrence of composite endpoint events in IgA nephropathy cohort.After univariate analysis and multivariate analysis of TCM cohort,systolic blood pressure,blood creatinine,24 h urinary protein,spleen and kidney Yang deficiency,and symptomatic edema were independent risk factors for the progression of IgA nephropathy.The third part evaluated the efficacy of TCM: 295 cases,152 Wmedicine cohort and143 TCM cohort were included.The two groups were statistically significant in age(P<0.001),triglycerides(P=0.006),LDL(P=0.006),urea nitrogen(P=0.001),urine erythrocyte count(P=0.009),serum IgA(P=0.007),urine specific gravity(P <0.001),E score(P=0.003),S score(P <0.001),and T score(P = 0.005).After multivariate analysis of Cox regression,the therapy variable HR and 95% Cl were 0.54(0.34-0.88),which were protective factors for the progression of IgAN to ESRD.In terms of the occurrence of endpoint events,the incidence of endpoint events in the TCM cohort was significantly lower than that in the Western medicine cohort(21.68% VS.39.47%,P=0.001),and TCM treatment effectively reduced the incidence of composite endpoint events by 17.79%.In different syndrome differentiation treatments,the incidence of splenic kidney Yang deficiency was significantly higher than that of non-splenic kidney Yang deficiency syndrome(65.22% VS.13.33%,P <0.001),with no significant difference among other syndrome types(P> 0.05).By drawing the Kaplan-Meier survival curve for the TCM treatment group and the western treatment group,the average time of the composite endpoint event in the TCM treatment group was 7.12(6.44-7.81)years,12.78(10.31-15.25)years in the western treatment group,and the TCM treatment group was 5.66 years later compared with the western treatment group.After stratifying the course of drug use,the difference between pulmonary temper deficiency(P=0.045),deficiency of qi and Yin(P=0.047),spleen and kidney Yang deficiency(P <0.001)in the course of TCM treatment was > 5 years)(P <0.05).Conclusion: 1.Through the screening of relevant literature and Meta-analysis,it was found that age,blood uric acid and MEST score T1-T2 were all related with the progression of IgA nephropathy to ESRD.2.In Cox regression univariate analysis and multivariate analysis,TCM syndrome elements: spleen,kidney deficiency,TCM edema,age,therapy,gender(male),urea nitrogen,24 h urinary protein,T score,T2 score,systolic blood pressure,blood uric acid were independent risk factors for the progression of IgAN;clinical patients with spleen and kidney deficiency should be actively treated to delay their progression to ESRD.3.TCM treatment is a protective factor for the progression of IgAN.TCM treatment can reduce the incidence of composite endpoint events,and regular long-term TCM treatment can effectively reduce the incidence of composite endpoint events in patients with IgAN deficiency of lung temper,deficiency of qi and Yin,and spleen and kidney Yang deficiency.