| Chronic primary glomerulonephritis (CPGN) is an autoimmune and inflammatory disease which results from a variety of causes leading to primary glomerular damage, with a long and lingering course as well as a progressive tendency. Traditional Chinese Medicine (TCM) treatment is very important to its clinical ease and syndrome research is the top priority for Chinese medicine treatment. In this thesis, through the observation of122cases of patients with CPGN, a pilot-investigation of syndrome variation rules was taken to improve the TCM syndrome differentiation and treatment for chronic nephritis.ObjectiveWe investigated four aspects by the collection and analysis of clinical cases. a. TCM syndrome distribution rules in CPGN; b. the relationship between specific syndrome types and micro pathology classifications; c. the relationship between specific syndrome types and main laboratory indices; d. the relationship between TCM syndrome and related influence factors, such as:gender, age, duration, medication and so on. We expect to bridge the gap between TCM syndrome differentiation and standardized modern medical technology and further to guide clinical practice.MethodsBased on compiled literature and related materials, this paper mainly proves the theoretical basis of CPGN, its etiology and pathogenesis of TCM, as well as the theoretical research progress of the syndrome type classifications. In addition, a clinical research is conducted on the TCM syndrome differentiation in CPGN patients to find rules and the relationship between syndrome type distribution and many affecting factors.Results1. Among122cases of CPGN patients, the Qi deficiency of kidney and spleen syndrome is the most common one as the deficiency syndrome, followed by Qi and Yin deficiency as well as Qi deficiency of lung and kidney syndrome. Dampness-heat type is most common as the excessive syndrome, followed by damp-turbidity syndrome. Among them, Qi deficiency of lung and kidney, Qi deficiency of spleen and kidney as well as Qi and Yin deficiency syndrome usually combine with damp-heat syndrome; Qi and Yang deficiency syndrome, Yang deficiency of lung and kidney syndrome usually combine with damp-turbidity syndrome; blood stasis syndrome usually combine with Qi and Yin deficiency.2. In the distribution of the deficiency syndromes, patients of stable, active and lag phases show differences. Qi and Yin deficiency as well as Qi deficiency of spleen and kidney syndrome are most common in stable phase. Qi deficiency of spleen and kidney syndrome is most common in active phase, followed by Qi and Yin deficiency and Qi deficiency of lung and kidney. Qi deficiency of spleen and kidney as well as Qi and Yang deficiency are most common in lag phase. In the distribution of the excessive syndromes, patients are not observed with obvious differences in correlation with clinical stages.3. In the distribution of the deficiency syndromes, there are obvious differences in patients of different CKD stages. Qi deficiency of spleen and kidney as well as Qi deficiency of lung and kidney syndrome are most common in CKD stage1; Qi deficiency of spleen and kidney as well as Qi and Yang deficiency are most common in CKD stage2; Qi and Yin deficiency is most common in CKD stage3. In the distribution of the excessive syndromes, there are also significant differences in different CKD stages. Damp-heat and water-wet syndrome are most common in CKD stage1; damp-heat syndrome is most common in CKD stage2; damp-turbidity and no accompanying symptom are most common in CKD stage3.4. In the distribution of the deficiency syndromes, there are no differences in CPGN patients of different severities. There are significant differences in the distribution of the excessive syndromes:damp-heat syndrome is most common in mild degree; water-wet syndrome is most common in middle degree; damp-turbidity syndrome is most common in heavy degree.5. Among122cases CPGN patients, those most common symptoms in order are tired and lack of power, waist ache, edema, dry mouth, poor appetite, spontaneous perspiration, frequent night urination, shortness of breath, lazy to talk, loose stools, etc. In terms of severity, mild and moderate levels of symptoms are more frequently recorded, while severe type is rarely appear. Only edema, waist ache, dry mouth, frequent night urination, tired and lack of power can be observed with serious degree.6. In CPGN patients with hypertension, Qi deficiency of spleen and kidney syndrome is seen most in deficiency syndromes, followed by Qi and Yang deficiency as well as Qi deficiency of lung and kidney syndrome. Yin deficiency symptoms are rarely seen. Damp-turbidity is seen most in excessive syndromes, followed by damp-heat and blood stasis syndrome.7. In CPGN patients with type2diabetes, Qi and Yin deficiency syndrome is seen most in deficiency syndromes, followed by Yin deficiency of liver and kidney as well as Qi deficiency of spleen and kidney syndrome. Damp-heat and blood stasis syndrome are seen most in excessive syndrome.8. In CPGN patients with renal failure, Qi deficiency of spleen and kidney as well as Qi and Yang deficiency syndrome are seen most in deficiency syndromes. Damp-turbidity syndrome is seen most in excessive syndromes. No differences are observed between compensatory stage and decompensatory stage of RF in distribution of syndromes.9. In CPGN patients with nephrotic syndrome (NS) level of proteinuria, Qi deficiency of spleen and kidney as well as Qi deficiency of lung and kidney syndrome are seen most in deficiency syndromes. Damp-heat and water-wet syndrome are seen most in excessive syndromes, followed by damp-turbidity and blood stasis syndrome.10. Among75cases of CPGN patients who undertaken renal biopsy check, MsPGN is seen most, followed by FSGS. MCD, MPGN and MN are rarely seen. There are obvious differences in the distribution of the deficiency syndromes in correlation with biopsy results. Patients with IgA nephropathy usually present Qi deficiency of spleen and kidney as well as Qi deficiency of lung and kidney syndrome. Patients with non-IgA nephropathy usually present Qi and Yang deficiency as well as Qi deficiency of spleen and kidney syndrome. Patients with MN usually present Qi deficiency of spleen and kidney syndrome. Patients with MPGN usually present Qi and Yin deficiency syndrome. Patients with FSGS usually present Qi deficiency of lung and kidney as well as Qi and Yin deficiency syndrome. There are no differences in the distribution of the excessive syndromes in correlation with biopsy results.11. There are certain differences between pure FSGS type patients and FSGS patients with MsPGN in the distribution of deficiency syndromes. Qi and Yang deficiency syndrome is seen most in pure FSGS, while Qi deficiency of lung and kidney as well as Qi and Yin deficiency syndrome are seen most in FSGS patients with MsPGN. There is no difference in the distribution of the excessive syndromes.12. Gender difference shows no impact on the distribution of the deficiency syndromes. However, there are obvious differences in the distribution of the excessive syndromes:damp-turbidity, blood stasis and water-wet syndrome are seen most in male patients, while damp-heat syndrome is seen most in female patients. 13. Age difference shows no impact on the distribution of the deficiency syndromes in CPGN patients. However, there are differences in the distribution of the excessive syndromes. Damp-heat syndrome is seen most in young people, followed by water-wet syndrome. Damp-heat syndrome is also seen most in the middle-aged, followed by dampness-turbidity syndrome. Dampness-turbidity syndrome is seen most in old age people, while water-wet syndrome is rarely seen.14. The course of disease does affect the distribution of the deficiency syndromes in CPGN patients:Qi deficiency of lung and kidney syndrome is seen most during<1year; Qi deficiency of spleen and kidney syndrome is seen most during1～5years; Qi deficiency of spleen and kidney as well as Qi and Yin deficiency syndrome are seen most during5～10years; Qi and Yin deficiency syndrome is most seen>10years. There are no differences in the distribution of the excessive syndromes in CPGN patients of different courses.15. Differences in medication also affect the distribution of the deficiency syndromes in CPGN patients. Among patients who simply take TCM, Qi deficiency of spleen and kidney syndrome is seen most, followed by Qi and Yang deficiency. Among patients who take both TCM and immunosuppressant, Qi and Yang deficiency as well as Qi deficiency of spleen and kidney syndrome are seen most. Among patients who take both TCM and glucocorticoid, Qi and Yin deficiency is seen most, followed by Qi deficiency of spleen and kidney syndrome. Among patients who take TCM, immunosuppressant and glucocorticoid, Qi deficiency of spleen and kidney syndrome is seen most, followed by Qi deficiency of lung and kidney syndrome as well as Qi and Yin deficiency. Differences in medication also affect the distribution of the excessive syndromes in CPGN patients. Among patients who simply take TCM, damp-heat and damp-turbidity syndrome are seen most. Among patients who take both TCM and immunosuppressant, damp-turbidity syndrome is seen most, followed by damp-heat syndrome. Among patients who take both TCM and glucocorticoid, blood stasis syndrome is seen most. Among patients who take TCM, immunosuppressant and glucocorticoid, damp-heat and water-wet syndrome are seen most.16. Haemoglobin level of patients of water-wet syndrome is higher than the non-water-wet group. Haemoglobin level of patients of damp-turbidity syndrome is lower than non-damp-turbidity group. Albumin level of patients of water-wet syndrome is lower than the non-water-wet group. Serum urea nitrogen level of patients of damp-heat syndrome is lower than the non-damp-heat group. Serum urea nitrogen level of patients of damp-turbidity syndrome is obviously higher than non-damp-turbidity group. Serum creatinine level of Qi deficiency of spleen and kidney syndrome patients is higher than the non-Qi deficiency of spleen and kidney group, and so is the damp-turbidity and non-damp-turbidity group, while that of the damp-heat syndrome patients is obviously higher than the non-damp-heat group. Total cholesterol level of water-wet syndrome patients is higher than that of the non-water wet group, and so is the blood stasis and non-blood stasis group.17. The connection between different syndromes and urinary occult blood (UOB) result is not obvious. The connection between deficiency syndromes and proteinuria level is also not obvious. But among patients of water-wet syndrome, the degree of3+proteinuria is seen most; among patients of damp-heat syndrome, the degree of and3+proteinuria are seen most; among patients of blood stasis syndrome, the degree of2+and3+proteinuria are seen most; among patients of damp-turbidity syndrome, the degree of-proteinuria is seen least.Conclusions1. The CPGN patients generally have deficiency of kidney as the basic pathogenesis, while also associated with the deficiency of both spleen and lung. Among all the deficiency syndrome types of CPGN, Qi deficiency of spleen and kidney syndrome is seen most, followed by Qi and Yin deficiency syndrome. The result may be associated with long-term oral glucocorticoid intake consuming Qi and Yin. Among all the excessive syndrome types, damp-heat and damp-turbidity syndrome are much more commonly seen. Dampness, heat, turbidity and toxicity are most important pathogens of chronic glomerular diseases and main reasons for progressive renal pathological damage.2. The rules of TCM syndrome distribution among CPGN patients with hypertension, type2diabetes, renal failure and NS level of proteinuria are different.3. Pathological diagnosis and deficiency syndrome distribution manifest certain relevance. In deficiency syndrome distribution, there are certain differences between pure FSGS patients and FSGS patients with MsPGN; in excessive syndrome distribution, there is no difference between these two groups.4. Both gender and age associate with the distribution of the excessive syndromes. Course of disease connects with the distribution of the deficiency syndromes. Differences in medication affect the distribution of both deficiency and excessive syndromes.5. The relation between major laboratory results (hemoglobin, serum albumin, urea nitrogen, serum creatinine, total cholesterol) and the TCM syndrome distribution has certain relevance.6. The relation between different syndromes and UOB severity is not obvious. The relation between excessive syndromes and proteinuria severity is obvious. |
PDF Full Text Request