Study On The Correlation Between Renal Tubulointerstitial Lesions And Blood Stasis Syndrome In Idiopathic Membranous Nephropathy

Objective: To study the correlation between tubulointerstitial lesions and blood stasis syndrome in idiopathic membranous nephropathy(IMN),to provide a reference mark for the microscopic differentiation of IMN blood stasis syndrome,and to explore the related risk factors of renal tubulointerstitial disease in IMN patients,so as to intervene in time.Methods: From April 2019 to December 2019,176 patients with IMN diagnosed by renal biopsy were collected from the Department of Nephrology of Shandong provincial hospital.The general condition,blood stasis syndrome score,pathological data and laboratory examination were collected and the data were analyzed by SPSS 22.0.Results:1.176 patients with IMN were mainly middle-aged and old,and the ratio of male to female was 1.26:1.2.All 176 patients were in early stage and stage II,and all of them were accompanied with renal tubulointerstitial damage.101 patients had mild lesions(T1 group),75 patients had moderate lesions(T2 group),and no patients had severe renal tubulointerstitial lesions.The incidence rate of FSGS in group T1 was significantly lower than that in group T2(P < 0.01).3.176 cases of IMN were classified according to syndrome differentiation.The deficiency of spleen and kidney yang and deficiency of spleen and kidney qi were the main syndromes.The proportion of patients in spleen and kidney yang deficiency group with blood stasis was higher,the difference was statistically significant(P < 0.05).Among 176 patients,155 had blood stasis syndrome,and the score of blood stasis syndrome in patients over 60 years old was significantly higher than that in 16-40 years old and 41-60 years old group(P < 0.05);the score of blood stasis in patients over 6 months was significantly higher than that in patients over 0-3 months and 3-6 months old(P < 0.05).In 155 IMN patients with blood stasis syndrome,the blood stasis score of T2 group was significantly higher than that of T1 group(P < 0.01).Spearman bivariate correlation analysis was performed on the renal tubulointerstitial lesion score and blood stasis syndrome score.The results showed that Rs = 0.461,P <0.01,and the two had a positive correlation.4.Analysis of clinical characteristics: the proportion of T2 group with hypertension and diabetes was significantly higher than that of T1 group(P< 0.05).ALB and EGFR in T1 group were higher than those in T2 group(P < 0.05),PR / 24 h,SCR,TG,TC and LDL-C were lower than those in T2 group(P < 0.05).Logistic regression analysis showed that hypertension,diabetes,FSGS,ALB,SCR and 24-hour urinary protein were independent risk factors for the aggravation of renal tubulointerstitial disease in IMN patients.Conclusion:1.The age and course of IMN are closely related to the degree of blood stasis;2.There is a positive correlation between the degree of renal tubulointerstitial lesions and the degree of blood stasis;3.The renal tubulointerstitial disease can be considered as the microscopic basis of syndrome differentiation of blood stasis in IMN patients,which can provide a reference mark for the use of drugs for promoting blood circulation and removing blood stasis;4.Hypertension,diabetes mellitus,pathology with FSGS,massive albuminuria,hypoalbuminemia,and the increase of serum creatinine are the risk factors for the aggravation of renal tubulointerstitial lesions in patients with IMN,which should be actively intervened in clinic.