| Objective: This study aims to the detection of performance for nephrotic syndrome in adults of Idiopathic Membranous Nephropathy(Idiopathic Membranous Nephropathy,IMN)and Secondary Membranous Nephropathy(Secondary Membranous Nephropathy,SMN)in patients with serum C1 q level and kidney tissues of C1 q deposition,as well as the relationship between TCM syndrome type,explore the pathological types of C1 q in the diagnosis of Membranous Nephropathy(Membranous Nephropathy,MN),and whether can be used as the objectivity of TCM syndrome types.Methods: 1.To collect 2019 May 01 solstice December 31,2019,Guangxi University of Chinese Medicine affiliated Rui Kang Hospital urology department,the Guangxi Zhuang Autonomous Region People's Hospital of renal medicine hospital nephrotic syndrome diagnostic standard and complete clinical data of patients with NS,further screening,finally into the study of 82 cases patients,were led by clinical disease patients,58 cases of membranous nephropathy patients as observation group,according to the pathological type will be further divided into observation group IMN and SMN group;Inaddition,24 patients with nephrotic syndrome except membranous nephropathy were in the control group.All the patients included in the study were grouped into TCM syndrome types.Specifically,it was divided into control group,IMN group and SMN group.According to TCM syndromes,it was divided into dampness-heat accumulation group,vein stasis group,spleen-kidney Yang deficiency group and liver-kidney Yin deficiency group.2.Collect information of patients in each group,including gender,age,onset time,disease course,etc.;Each patient underwent renal biopsy and related examinations,including blood routine,urine routine,liver and kidney function,blood lipid,coagulation function,hepatitis B two-and-a-half halves,electrolytes,blood glucose,24-hour urinary protein quantification,and anti-nuclear antibody.Relevant clinical data were collected,including hemoglobin,serum creatinine,urea nitrogen,24-hour urinary protein quantification,blood lipids,serum albumin and other indicators.According to the four diagnostic data,it can be divided into four TCM syndromes:damp-heat accumulation syndrome,vein stasis syndrome,spleen-kidney Yang deficiency syndrome and liver-kidney Yin deficiency syndrome.3.Serum of all patients included in the study was collected,cryopreserved,and tested for C1 q antibody;Detection method of serum C1q:Human serum samples were stored at 2-8 ?,and two antibody kits were added to the samples respectively.The samples were incubated for 5 minutes and the data were read out.4.Immunofluorescence,electron microscope and light microscope were used to detect the expression of C1 q in renal pathological tissues,and semi-quantitative scoring was performed to analyze the correlation between C1 q and TCM syndromes.Results: 1.Age and sex of 82 NS patients were compared,and gender difference was not statistically significant(P>0.05).The age of onset was the highest in the IMN group,41-60 years old.In terms of age,the age of patients in the IMN group was higher than that in the SMN group and the control group,with statistically significant difference(P<0.05).2.In terms of age and gender of TCM syndromes,the age of onset of spleen-kidney Yang deficiency syndrome was 53.69±14.12 years old,which was higher than that of patients with liver-kidney Yin deficiency syndrome,vein occlusion group and damp-heat accumulation syndrome,with statistically significant difference(P<0.05).The number of male patients with liver-kidney Yin deficiency was less than that of female patients,with a male-to-female ratio of 0.72 to 1.The proportion of male and female patients of other syndrome types was more than that of female patients,and the difference was statistically significant(P<0.05),suggesting that the incidence of NS patients was higher in males.3.The C1 q results of renal pathology showed that the C1 q positive rate in SMN group(94.7%)was higher than that in IMN group(69.2%)and control group(62.5%),with statistically significant difference(P<0.05).Theresults of serum C1 q level in the three groups showed that the difference of serum C1 q water in the three groups was statistically significant(P<0.05 or P<0.01).Compared with the control group,the serum C1 q level in the IMN group(185.54±51.48)g/L was higher than that in the SMN group(113.68±46.68)g/L and the control group(110.29 ± 41.12)g/L,with statistically significant differences(P<0.05 or P<0.01),while there was no significant difference between the SMN group and the control group(P>0.05).4.Correlation between serum C1 q and renal C1 q expression and clinical indicators in NS patients showed that correlation coefficients of renal C1 q and serum C1 q and HGB were-0.461 and-0.290,respectively,indicating negative correlation between renal C1 q and serum C1 q and HGB(P<0.05).The correlation coefficient between renal C1 q and urea nitrogen was 0.114,suggesting a positive correlation between renal C1 q and urea nitrogen(P<0.05).Renal C1 q was not correlated with creatinine,uric acid,total cholesterol or 24-hour urinary protein(P>0.05).The correlation coefficients between serum C1 q and renal tissue C1 q and urea nitrogen were-0.461 and-0.283,respectively,with negative correlation(P<0.05).The correlation coefficient between serum C1 q and serum albumin was 0.256,with a positive correlation(P<0.05).Serum C1 q was not associated with creatinine,uric acid,total cholesterol,triglyceride,HGB,24-hour urinary protein(P>0.05).5.The comparison of TCM syndromes among the three groups showed that spleen-kidney Yang deficiency syndrome accounted for the highestproportion in the IMN group and SMN group(46.2% and 42.1%,respectively),suggesting that THE TCM syndromes of MN patients were mostly spleen and kidney Yang deficiency syndrome.6.The correlation between TCM syndromes and renal tissue C1 q showed that the correlation coefficient between renal tissue C1 q and TCM syndromes suggested that there might be no correlation between renal tissue C1 q and TCM syndromes(r=0.070,P>0.05).The correlation between serum C1 q and clinical data of patients with different TCM syndromes showed that:(1)Serum C1 q of liver-kidney Yin deficiency syndrome was negatively correlated with uric acid(r=-0.468,P<0.05),while serum C1 q of liver-kidney Yin deficiency syndrome was not correlated with creatinine,urea nitrogen,total cholesterol,triglyceride,serum albumin,HGB,24-hour urinary protein(P>0.05).(2)There was no correlation between serum C1 q with creatinine,uric acid,urea nitrogen,total cholesterol,triglyceride,serum albumin,HGB and 24-hour urinary protein(P>0.05).(3)the spleen kidney Yang deficiency syndrome serum C1 q and triglycerides have negative correlation(r=0.370,P<0.05),spleen and kidney Yang deficiency syndrome serum C1 q and blood albumin has a positive correlation(r=0.449,P<0.05),spleen and kidney Yang deficiency syndrome C1 q and creatinine,uric acid,urea nitrogen,serum total cholesterol,HGB,24 hour urine protein between quantitative correlation in(P > 0.05);(4)There was negative correlation between serum C1 q and total cholesterol(r=-0.623,P<0.05),and there was no correlation between serum C1 q and creatinine,uric acid,urea nitrogen,triglyceride,serum albumin,HGB,24-hour urinary protein(P>0.05).Conclusions: 1.The expression of C1 q is different in different types of NS.The serum C1 q level of IMN is higher than that of SMN,while the positive rate of C1 q in SMN kidney tissue is higher than that of primary,suggesting that C1 q may be involved in the pathogenesis of SMN.2.The most common type of membranous nephropathy is spleen-kidney Yang deficiency syndrome.3.There may be no correlation between TCM syndrome type and renal tissue C1 q expression in patients with MN. |
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