| Objective1. To compare the incidence of mucocutaneous inflammations between glomerulonephritis patients and general population.2. Since the casual relationship of mucocutaneous inflammations and IgA nephropathy has been validated in the literature. IgA nephropathy can be taken as a model for us to study why patients with IgA nephropathy had a higher probability to suffer from mucocutaneous inflammations and factors that associated with these inflammations in order to explore the possible causes and preventive strategies.3. To compare the incidence of mucocutaneous inflammations among patients with various types of glomerulonephritis and find out the different clinic indicators that could be potentially used to predict the pathologic patterns of glomerulonephritis.4. As one type of TCM syndrome may contain various of TCM constitutions, we further explored the interactions between TCM constitutions, TCM syndromes and their impacts on the pathology of glomerulonephritis.Methods1. A case-control study was made to compare the incidence of mucocutaneous inflammations between 85 patients with nephritic isolated microscopic hematuria and 85 general population without glomerulonephritis.2. An epidemiological field investigation was made to collect the data about mucocutaneous inflammation history, inflammation triggers and TCM constitutions of 162 patients with IgA nephropathy. According to these data, we studied the possible reason of higher incidence of mucocutaneous inflammations in patients with IgA nephropathy, analysed the correlation among TCM constitution and mucocutaneous inflammations, inflammation triggers to seek for appropriate preventive strategies.3. The data of mucocutaneous inflammations, clinic characteristics TCM constitutions and syndromes of 226 patients who had been proven pathologic pattern by biopsy were collected by epidemiologic survey to explore the incidence of inflammations among the different kinds of glomerulonephritis and find out the different clinic indicators.4. The investigations were similar with the part three. To collect the data of different TCM constitutions of 104 cases in spleen-kidney qi deficiency with IgA nephropathy and 102 cases with membranous nephropathy studied the impacts of TCM constitutions, syndromes on clinic-pathology of glomerulonephritis in order to provide the basis for pathology prediction.Results1. The comparison of mucocutaneous inflammations between patients with glomerulonephritis and general population.1.1 There were no difference between the two groups in baseline characteristics. The incidence of mucocuaneous inflammaitons was higher in patients group than that of the control group and the difference was more clear when the number of different types of inflammations was considered. Cold, frequency of cold over 3 times a year, chronic pharyngitis, chronic tonsillitis, chronic rhinitis, oral ulcer, frequency of oral ulcer over 2 times a year, reflux esophagitis and chronic skin diseases were significantly differed between the two groupso The more frequent episodes of cold and oral ulcer was associated with higher incidence of nephrotic hematuria.Why did the patents with glomerulonephritis have a higher incidence of repeated or chronic mucocutaneous inflammations? Which factors may trigger these inflammations?2. An study on mucocutaneous inflammations and their possible triggers in IgA nephropathy patients.2.1 The demographic data of 162 patients with IgA nephropathyThere were 92 men and 70 women. The mean age was 35.9±12.5 years and mean duration of the disease was 42.9±35.5 months.19 patients presented with nephrotic syndrome(11.7%),25 patients with gross hematuria(15.4%),150 patients with microscopic hematuria(92.6%).2.2 The distribution of TCM constitutions in the IgA nephropathy patients.The TCM constitutions of the studied patient group wereas follow:78 cases with normal constitution (48.1%),23 cases with Qi deficiency constitution (14.2%) and 20 cases with Yang deficiency constitution (12.3%),7 cases with Qi stagnation constitution (4.3%),15 cases with special constitution (9.3%) and 6 cases with blood stasis constitution (3.7%).2.3 The distribution of mucocutaneous inflammations.There were 9 kinds of repeated or chronic inflammations in these patients:141cases with inflammations(87%) and 21cases without(13%),24 patients with chronic rhinitis(14.8%),61 patients with chronic pharyngitis(37.7%),28 patients with chronic tonsillitis(17.3%),68 patients with gingivitis or periodontitis(42%),43 patients with repeated upper respiratory infection(26.5%),35 patients with chronic colitis(21.6%),31 patients with chronic gastritis/duodenal ulcer(19.1%)and 71 patients with repeated skin disease(43.8%). Majority of the patients had more than one kind of inflammation particularly 2-3 kinds of inflammations..2.4 The possible triggers for mucocutaneous inflammationsThe possible triggers of inflammations were:70 cases due to climate change(43.2%),37cases to dietary factors(27.2%),48 cases to over excercise(29.8%),44 cases to insomnia(27.2%),11 cases to emotional factors(6.8%)and 19 cases to allergic factors(11.7%).2.5 The comparison of TCM constitution and types of mucocutaneous inflammations.The prevalence of chronic rhinitis was higher in Qi deficiency constitution than that of the normal constitution(P<0.05). Repeated upper respiratory infection was commonly seen in patients with Qi deficiency and Yang deficiency constitution as compared with the normal constitution(P< 0.05). Patients with Yin deficiency were easier to get chronic gastritis and duodenal ulcer than that of the normal constitution(P<0.05). The prevalence of chronic skin disease was higher in patients with damp-heat constitution than that of the normal constitution(P<0.05).2.6 The comparison of TCM constitutions and possible triggers of mucocutaneous inflammations.The possible triggers of inflammations were significantly differed among patients with different TCM constitutions. Climate change may more easily induce inflammations in patients with Qi deficiency and Yang deficiency as compared to patients with normal and phlegm-dampness constitution.Inappropriate diet may induce or exacerbate inflammations in patients with Yin deficiency and damp-heat constitution as compared to patients with normal constitution and Yang deficiency constitution. Inflammation in patients with phlegm-dampness constitution may get worse under allergic factors. (P<0.05).Although there were high incidence of mucocutaneous inflammations in IgA nephropathy patients it is unclear in patients with other types of glomerulonephritis. Can TCM constitutions and syndromes be used to predict the pathologic patterns of glomerulonephritis?3. The comparison of mucocutaneous inflammations in patients with different pathologic patterns of glomerulonephritis.3.1 Baseline characteristics of 226 casesThere were 133 men and 93 women with age from 18 to 55 years.. The mean duration of the disease were 38 (12,48) months. There were only 1 patient with focal segmental glomerular sclerosis (0.4%),136 patients with IgA nephropathy (IgAN)(60.2%),15 patients with membranous nephropathy plus IgA deposition (IgA+MN)(6.6%),61 patients with membranous nephropathy (MN)(27%), and 13 patients with minimal change disease (MCD)(5.8%).3.2 The TCM constitutions and TCM syndromes of the 226 cases223 cases included in the final analysis with complete data. TCM syndrome types were mainly spleen-kidney deficiency in 152 cases (68.2%) and spleen kidney Yang-deficiency in 48 cases (21.5%). Superficiality types were 32 cases with fluid-dampness (14.3%),48 cases with damp syndrome (21.5%),5 8cases with damp-heat syndrome (26%)and 32 cases with blood stasis pattern(14.3%). TCM constitutions were:78 cases with normal constitution (35.4%),78 cases with Qi-deficiency(35.4%),39 cases with Yang-deficiency(17.5%) and 40 cases with phlegm-dampness constitution(17.9%).3.3 Effect of mucocutaneous inflammations on different pathologic pattern of glomerulonephritis.As there was only one case of FSGS, we did not include FSGS in the final analysis. Chronic rhinitis, chronic pharyngitis and gingivitis or periodontitis, repeated acne were differed significantly among the four pathological types(P< 0.05). Repeated or chronic upper respiratory inflammations and chronic skin diseases were more commonly seen in patients with IgA nephropathy than that of the membranous nephropathy (P< 0.05). Gingivitis or periodontitis were more commonly seen in MN and IgA+MN than that of IgA nephropathy. (P<0.05).3.4 The comparison of different clinic indicators among the different pathological patterns of glomerulonephritis.There were 20 indicators significantly differed among the four groups, including age, medical history, clinic indicators, TCM constitutions and TCM syndromes. Age, nephrotic syndrome, renal function,24-hour urine protein, serum albumin, serum creatinine were all significantly differed between IgAN and the other three groups (P<0.01). Patients with MCD were younger than that of MN(P<0.01). Serum IgA and C3 were higher while IgE was lower in patients with IgAN than that of MN (P< 0.01). Spleen-kidney deficiency and yang-deficiency constitution was more commonly seen in MCD than that of IgANC/7 <0.01), The percentage of phlegm-dampness constitution was higher in IgAN than that of MN(/7<0.01).As one type of TCM syndrome may contain various of constitutions, it is not clear how the interaction between TCM constitutions and TCM syndromes may impact on the clinical pathology of the kidney.4. The study on TCM constitutions, TCM syndromes and and their relationship with pathological patterns of glomerulonephritis.4.1 Comparison of different TCM constitutions of patients with spleen-kidney Qi deficiency in IgA nephropathy patients.4.1.1 The comparison of Katafuchi scores and clinic indicators among various TCM constitutions.There were three TCM constitutions in 104 patients with spleen and kidney qi deficiency:40 patients with normal constitution,19 patients with qi deficiency constitution and 45 patients with damp constitution (including damp-heat and phlegm-dampness type). The glomerular scores of qi deficiency constitution were significant lower than that of normal constitution. The renovascular scores of damp constitution were significant higher than that of normal constitution. The glomerular scores and total scores tended to be lower in qi-deficiency and higher in damp constitution with the normal constitution between, so did the total cholesterol, triglyceride, creatinine and urea acid.4.1.2 Comparison of different TCM constitutions in patients with membranous nephropathy.4.1.2.1 Baseline characteristics and pathology comparisonThe TCM syndromes in patients with membranous nephropathy were 68 cases in spleen-kidney qi deficiency(64.3%) and 30 cases in spleen-kidney yang deficiency(28.3%), 1case in pulmonary-renal qi deficiency(0.9%),2 cases in qi-yin deficiency(1.9%), 1case in yin-yang deficiency(0.9%).Only patients with spleen-kidney qi deficiency and spleen-kidney yang deficiency were included in the present analysis. There were 102 patients,43 patients with normal constitution (42.2%),11 with qi deficiency (10.8%),14 with damp constitution (including damp-heat and phlegm-dampness constitution) in spleen and kidney qi deficiency (13.7%) while 24 for yang deficiency (23.5%) and 6 for non-yang deficiency constitution (5.9%) in spleen and kidney yang deficiency. There were no differences in age, duration of the disease, hypertension. gender distributions among the groups. The body mass index were lower in normal, yang-def iciency constitutions and higher in damp constitution with qi deficiency and non-yang deficiency constitutions the between. Stage II membranous nephropathy was more commonly seen in damp constitution than that of normal constitution and qi deficiency.4.1.2.2 The comparison of laboratory results among the five constitutionsThe creatinine in damp constitution was higher than that of qi deficiency and yang deficiency constitution.24-hour urine protein indamp constitution was significanly higher than that of the other two constitutions.Conclusion1. The incidence of mucocuaneous inflammaitons was higher in patients with nephritic hematuria than that of the normal population. Cold, frequency of cold over 3 times a year, chronic pharyngitis, chronic tonsillitis, chronic rhinitis, oral ulcer, frequency of oral ulcer over 2 times a year, reflux esophagitis and chronic skin diseases showed higher incidence in the patient group than that of normal population.2. The incidence of mucocutaneous inflammations was high in patients with IgA nephropathy.3. IgA nephropathy was possibly a disease existed in the broad spectrum from auto-inflammatory disease to autoimmune disease.4. TCM constitutions were correlated with mucocutaneous inflammations, especially between Qi deficiency, Yang deficiency constitutions and upper respiratory inflammations, between yin deficiency and chronic gastritis or duodenal ulcer, and between damp-heat constitution and chronic skin disease.5. TCM constitutions were linked with possible triggers of inflammations, such as qi deficiency and yang deficiency constitutions were more easily triggered by climate changes, yin deficiency and damp-heat constitution by dietary factors, damp-heat constitution by allergic factors. These can be used to guide for individualized prevention.6. Intraction between constitution and environment may be an important basis for pathogenesis of IgA nephropathy.7. The distribution of mucocutaneous inflammations was differed among different pathological patterns of glomerulonephritis.8. There were other clinical indicators that were significantly differed among the different pathological patterns of glomerulonephritis, including clinic indicators and laboratory results, TCM constitutions and syndromes etc.9. Our study suggest that these indicators may provide a basis for the establishment of prediction model for renal pathology.10. When patients with Qi deficiency developed spleen-kidney Qi deficiency are defined as the Qi deficiency caused by lack of innate endowment and normal or damp constitution developed spleen-kidney qi deficiency defined as acquired Qi deficiency caused by poor-nourishment after birth, patients with qi deficiency caused by lack of innate endowment seemed to have less severe renal pathology than that of acquired Qi deficiency caused by poor-nourishment after birth both in IgA nephropathy and in membranous nephropathy. |
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