Correlation Analysis Between TCM Syndrome Differentiation And Clinical Pathology And Risk Factors Of IgAN With Partial Crescentic Formation

Objective:To investigate the mechanism of the disease.This paper reviews the four diagnosis and clinical pathological data of IgAN patients,analyzes the distribution of syndrome type and laboratory index,and explores the risk factors affecting the formation of some crescent bodies,which provides a basis for the prognosis of patients with IgAN.Method:1.151 patients with IgAN who met the standard of nanogram were selected from Nephrology Department of the First Affiliated Hospital of Tianjin University of traditional Chinese medicine,and the distribution and statistical analysis of TCM syndrome types were carried out.2.according to the results of renal puncture biopsy,patients were divided into groups according to the following: C0 group was non crescent body,C1 group was accompanied with crescent body,and the correlation of TCM syndrome type,clinical pathological index and difference among groups were analyzed to screen the risk factors affecting the formation of some crescent bodies.Result:1.A total of 151 cases were collected,including 79 males and 72 females.The youngest was 13 years old,the oldest was 71 years old,and the average age was 34(27,47)years old.Among them,deficiency of both qi and Yin is the most common syndrome in both male and female patients.The patients with lung spleen qi deficiency syndrome and Qi Yin deficiency syndrome were mostly 21-40 years old,while the patients with spleen kidney yang deficiency syndrome and liver kidney yin deficiency syndrome were mostly over 30 years old.The patients with lung spleen qi deficiency syndrome,Qi Yin deficiency syndrome,liver and kidney yin deficiency syndrome were mostly in stage 1-2 of chronic kidney disease,while the patients with spleen and kidney yang deficiency syndrome were mostly in stage 2-3 of chronic kidney disease.Patients with lung spleen qi deficiency syndrome and Qi Yin deficiency syndrome have less or more hypertension grade 1,patients with spleen kidney yang deficiency syndrome have more hypertension grade 2-3,and patients with liver kidney yin deficiency syndrome have different degrees of hypertension.Age,CKD stage and blood pressure classification had statistical differences in the distribution of this deficiency syndrome(P < 0.05),but gender had no statistical difference in the distribution of this deficiency syndrome(P > 0.05).2.Among 151 IgAN patients,there were 24 cases of lung and spleen qi deficiency,61 cases of Qi and yin deficiency,33 cases of liver and kidney yin deficiency and 33 cases of spleen and kidney yang deficiency;Among 151 IgAN patients,129 cases were concurrent and35 cases were multiple.Among them,there were 20 cases of concurrent wind heat syndrome,23 cases of concurrent dampness turbidity syndrome,61 cases of concurrent dampness heat syndrome and 60 cases of concurrent blood stasis syndrome.3.Blood uric acid,blood urea nitrogen,serum creatinine,glomerular filtration rate,hemoglobin in the distribution of this deficiency syndrome were statistically different(P <0.05).The mean arterial pressure,blood urea nitrogen,serum IgA and fibrinogen were statistically different in the distribution of blood stasis syndrome(P < 0.05),while the other clinical indicators were not statistically different in the distribution of this deficiency syndrome(P > 0.05).The mean arterial pressure,blood urea nitrogen and serum creatinine of patients with Qi Yin deficiency syndrome were significantly lower than those of patients with spleen kidney yang deficiency syndrome,and the glomerular filtration rate was significantly higher than that of patients with spleen kidney yang deficiency syndrome;The levels of serum uric acid and urea nitrogen in patients with liver kidney yin deficiency syndrome were significantly lower than those in patients with spleen kidney yang deficiency syndrome;The hemoglobin level of patients with lung spleen qi deficiency syndrome was significantly higher than that of patients with liver kidney yin deficiency syndrome(P < 0.05).4.There were statistical differences in Lee’s classification and katafuchi’s semi quantitative score in the distribution of this deficiency syndrome(P < 0.05).Lee’s classification of lung and spleen qi deficiency and Qi and yin deficiency was significantly lower than that of spleen and kidney yang deficiency.The evolution of qi deficiency Yin deficiency Yang deficiency was more severe with the aggravation of Lee’s classification.The glomerular integral and tubulointerstitial integral of spleen kidney yang deficiency syndrome were significantly higher than those of spleen lung qi deficiency syndrome,Qi Yin deficiency syndrome and liver kidney yin deficiency syndrome;The vascular integral of spleen kidney yang deficiency syndrome was significantly higher than that of Qi Yin deficiency syndrome.There were statistical differences in the distribution of blood stasis syndrome among the pathological grades(P < 0.05).Blood stasis syndrome is more common in Lee’s grade III-IV,while non blood stasis syndrome is mainly in grade II-III.The glomerular integral,tubulointerstitial integral and vascular integral of blood stasis syndrome were significantly higher than those of non blood stasis syndrome.5.Among 151 IgAN patients,there were 107 patients without crescent formation(Group C0)and 44 patients with crescent formation(Group C1).In group C0,there were 54 males and 53 females,with a ratio of 1.02:1;In group C1,there were 44 persons,25 males and 19 females,with a male to female ratio of 1.32:1;There were significant differences in gross hematuria history,mean arterial pressure level and chronic kidney disease stage between the two groups(P < 0.05).There was no significant difference in gender,age,body mass index(BMI),course of disease and blood pressure grade between the two groups(P > 0.05).6.In 151 IgAN patients,there were 22 cases of simple deficiency syndrome and 129 cases of deficiency syndrome and excess syndrome.In group C1,there was 1 case(2.2%)with simple deficiency of origin and 43 cases(97.8%)with deficiency of origin and excess of origin;In group C0,there were 21 cases(19.6%)with simple deficiency of origin and 86cases(80.4%)with deficiency of origin and excess of origin.There were statistical differences between the two groups(P < 0.05).In group C1,spleen and kidney yang deficiency syndrome was the most common,and the concurrent syndrome was mainly manifested as damp heat syndrome and blood stasis syndrome;In group C0,Qi Yin Syndrome was the main deficiency syndrome,and damp heat syndrome was the main concurrent syndrome;There was no significant difference in the distribution of crescentic body types between the two groups(P >0.05).7.The levels of proteinuria(proteinuria grade),blood lipid(triglyceride)and renal function(serum creatinine and blood urea nitrogen)in group C1 were significantly higher than those in group C0(P < 0.05);The levels of high density lipoprotein,plasma albumin and glomerular filtration rate in group C0 were significantly lower than those in group C0(P <0.05).There was no significant difference in other indexes between the two groups(P > 0.05).8.Lee’s classification: the Lee’s classification in group C1 was more severe than that in group C0(P < 0.05).Group C1 was distributed in Lee’s grade III and above;The distribution of group C0 was above grade II.Oxford classification: the degree of mesangial cell proliferation,capillary proliferation and renal tubular atrophy / interstitial fibrosis in Oxford classification of C1 group were more severe than those in C0 group(P < 0.05).Katafuchi’s semi quantitative score: the mesangial proliferation score,segmental damage score,spherical sclerosis score,tubulointerstitial inflammatory cell infiltration / interstitial fibrosis score in group C1 were more severe than those in group C0(P < 0.05).IgA + C3 deposition was the most common in the two groups,and there was no significant difference between the two groups(P > 0.05).9.Crescentic formation was positively correlated with proteinuria,mean arterial pressure,triglyceride,blood urea nitrogen and serum creatinine,and negatively correlated with high density lipoprotein,glomerular filtration rate and plasma albumin.In IgAN patients with partial crescent formation,intracapillary proliferation(E1),segmental sclerosis and adhesion(S1),tubular atrophy or renal interstitial fibrosis(T1+ 2)were positively correlated with proteinuria,and negatively correlated with glomerular filtration rate.There was no significant correlation between the other clinical and pathological indexes and the baseline clinical indexes.10.The regression analysis results of mean arterial pressure,24 urine protein,triglyceride,high density lipoprotein,EGFR,glomerular score and tubulointerstitial score were statistically significant(P < 0.05).Conclusion1.Distribution of syndrome type of traditional Chinese medicine: the patients with crescent body group are often accompanied by spleen kidney yang deficiency,often combined with multiple syndromes.Damp heat,blood stasis throughout the course of the disease.The age,renal function,blood pressure,blood uric acid level and other clinical characteristics of IgAN patients were related to the distribution of deficiency syndrome.The evolution of qi deficiency Yin Yang deficiency also increased with the pathological classification,the degree of integration and the more serious the expression.2.Clinical and pathological features: IgAN has high incidence rate of some crescentic formation,and the clinical manifestations(albuminuria,renal insufficiency,hyperlipidemia,hypoproteinemia)are heavier.The higher the pathological grade and integral,the more severe the proliferation,segmental damage and tubulointerstitial lesions in mesangial cells /capillaries,the more severe the damage degree of some crescent formation is.3.Risk factors influencing the formation of Crescent: mean arterial pressure,24 urine protein quantification,triglyceride,HDL,EGFR,glomerular integral and renal tubule interstitial integral are the risk factors of crescent formation.