| Purpose:To study the correlation between the deficiency syndrome types and clinicopathological of 90 cases of primary IgA nephropathy with hematuria.Methods:A total of 90 patients who were diagnosed with primary IgA nephropathy and met the inclusion criteria in outpatient and in-patient Settings from March 2017 to March 2019 were collected.The basic information of patients and their deficiency syndrome in four Chinese medical examinations,laboratory indicators and pathological data were collected.Then four syndromes were divided:lung spleen qi deficiency syndrome,Qi-yin deficiency syndrome,liver-kidney yin deficiency syndrome,and spleen-kidney yang deficiency syndrome.Statistical methods was conducted to obtain the correlation between the deficiency syndrome of IgA nephropathy with hematuria and its clinical indicators and pathology.Results:1.Among the 90 IgAN patients with hematuria,the age of onset was 16?69 years old.The average age of onset was 36.60±9.72 years old.IgAN patients aged 20?40 years was the mos,accounting for 71.11%.The course of disease ranged from 12 days to 11 years.In most cases,the course ranged from a month to a year,with a median of 8 months.There was a positive correlation between course of disease and onset age(P<0.05).There were 29 cases(32.22%)with infectious causes,including upper respiratory tract infection(82.76%),urinary tract infection(13.79%),and gastrointestinal infection(3.45%).There were 5 cases of gross hematuria after infection.Hypertension was found in 16 patients,11 of which were slightly elevated.The mean SBP was 131.87± 10.50mmHg and DBP was 77.98±8.36mmHg.According to the URBC level,5 groups were divided among these patients.The patients with URBC of 150-300/ul were the most(53.33%),and the next was 300-450/ul(27.78%),the number of cases with URBC count of 450-600/ul was 10%,the number of cases with URBC count of<150 and>600 were 4.44%respectively.Stage 1 and 2 were the main stages of CKD,accounting for 62.22%and 30%respectively,stage 3 accounted for 7.78%,no stage 4 or 5.There was no difference in the distribution of gender in different types of deficiency syndrome.The integral of TCM symptoms is expressed as lung spleen qi deficiency syndrome<Qi-yin deficiency syndrome<liver-kidney yin deficiency syndrome<spleen-kidney yang deficiency syndrome.The number of patients with Qi-yin deficiency syndrome and liver-kidney yin deficiency syndrome was the largest,with 29 cases each accounting for 32.22%,followed by spleen and kidney Yang deficiency syndrome with 19 cases(21.11%),lung spleen-deficiency with 13 cases(14.44%).The pathological Lee's grade was most commonly seen in grade II and III,accounting for 32.22%,27.78%separately,followed by grades I,IV and V,which accounted for 18.89%,13.33%and 7.78%respectively.IgA+C3 was the main immunologic deposit,accounting for 92.22%,followed by IgA+IgM+C3(5.56%)and IgA(2.22%),IgA+IgM wasn't contain.2.The relationship between URBC and clinic,pathology and the deficiency syndrome types:The level of URBC was positively correlated with 24hUTP and BUA in IgAN patients with hematuria(P<0.05).There was no significant correlation between URBC and TC,TG,BUN,and ALB(P>0.05).There was a positive correlation between BUA and 24hUTP(P<0.01),and a negative correlation between BUA and Alb(P<0.05).There was no significant difference in the distribution of URBC among different syndrome types(P>0.05).With the aggravation of Lee's grade,the level of URBC count showed an increasing trend.The level of URBC count of grade I,II were lower than that of grade IV,V(P<0.05).3.The relationship between hematuria stratification and clinic,pathology and the deficiency syndrome types:There was a significant positive correlation between different levels of hematuria and 24hUTP,UOB and Lee's grading(P<0.01).There was no significant correlation between CKD stage and hematuria stratification,neither proteinuria stratification(P>0.05).There were significant differences on types of deficiency syndrome among different hematuria stratification(P<0.01),and there was no significant difference on the distribution of immunologic deposits among different hematuria stratification(P>0.05).4.The relationship between pathology and clinic:With Lee's grades aggravating,24hUTP showed an increasing trend.The proteinuria level of Grade IVwere significantly higher than that of grade I(P<0.01).The proteinuria levels of grade IV,V were higher than grade II(P<0.05).The proteinuria level of grade V is higher than grade I(P<0.05).There was significant difference between Grade IV and I on the level of 24hUTP(P<0.01).Grade IV and V were different from grade ? respectively(P<0.05).Grade V and I were statistically different(P<0.05).The serum creatinine level increased with the aggravation of pathological grade.There was no significant correlation between Lee's grade and CKD stage(P>0.05).There was no statistical difference in the distribution of clinical indexes,and immunologic deposit among all Lee's grades.5.Relationship between deficiency syndrome and clinic:The level of 24hUTP in the spleen-kidney yang deficiency syndrome was the highest,and the lung spleen qi deficiency syndrome were the lowest(P<0.05).DBP and Scr showed the increasing rule:lung spleen qi deficiency syndrome<Qi-yin deficiency syndrome<liver-kidney yin deficiency syndrome<spleen-kidney yang deficiency syndrome.Howerver the serum Alb was the opposite,showing the decreasing rule lung:spleen qi deficiency syndrome>Qi-yin deficiency syndrome>liver-kidney yin deficiency syndrome>spleen-kidney yang deficiency syndrome.The DBP of spleen-kidney yang deficiency syndrome was higher than that of other three types(P<0.05),and was significantly higher than that of liver-kidney yin deficiency syndrome(P<0.01).The SBP of spleen-kidney yang deficiency syndrome was higher than that of qi-yin deficiency syndrome(P<0.05).The Scr level of spleen-kidney yang deficiency syndrome was greater than that of lung spleen qi deficiency syndrome(P<0.05).The serum Alb level of Qi-yin deficiency syndrome was higher than that of spleen-kidney yang deficiency syndrome(P<0.05).There was no significant difference in the distribution of URBC,BUN,BUA,TC and TG among the syndromes(P>0.05).6.Relationship between deficiency syndrome types and pathology:Among the 90 patients,71 cases(78.89%)were grade I and II with mild pathological manifestation.While grade IV and V with more serious manifestation accounted for 21.11%,of which the cases of Qi-yin deficiency syndrome and liver-kidney yin deficiency syndrome were the most.There was no significant difference between Lee I,II and ??? in the distribution of TCM syndrome types(P>0.05).IgA+C3 daposits was found in 12.22%,30%,31.11%and 18.89%patients in each syndrome types respectively.There was no significant difference between the Lee's grade and the immunologic deposit among different types of the syndromes(P>0.05).Conclusion:1.The majority of IgAN patients with hematuria were young adult females,and the course of disease was positively correlated with the age of onset.The clinical manifestations were slight,and some of them were accompanied by mucosal infection before the onset,few were accompanied by hypertension,and the renal function was better.The pathology of the viscera varies from light to heavy.2.The level of URBC count increased with the increase of 24hUTP,BUA and Lee's grade.The higher the level of hematuria stratification,the more 24hUTP,and the heavier the Lee's pathological grade.3.With Lee's grades aggravating,24hUTP and Scr showed an increasing trend.4.The deficiency syndrome mainly consists of Qi-Yin deficiency syndrome and liver-kidney yin deficiency.From lung spleen qi deficiency syndrome to Qi-yin deficiency syndrome,liver-kidney yin deficiency syndrome,spleen-kidney yang deficiency syndrome,the disease is getting worse,and the TCM symptom score,DBP,Scr increased,the Alb decreased.The level of 24hUTP in the spleen-kidney yang deficiency syndrome was the highest,and the lung spleen qi deficiency syndrome were the lowest. |
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