| ObjectiveTo investigate the general incidence,clinical characteristics and TCM syndrome distribution of idiopathic membranous nephropathy(IMN)in Beijing and hebei,To explore the clinical factors affecting the TCM syndrome of IMN,To provides the basis for the TCM syndrome differentiation and treatment of IMN.MethodsUsing the method of epidemiological cross-sectional survey,the clinical questionnaire of IMN TCM syndromes was formulated,and IMN patients' basic information,laboratory indicators,TCM symptoms and tongue and pulse information were collected,and IMN database was established.185 cases were investigated in Xiyuan Hospital of China Academy of Chinese Medical Sciences,and 91 cases were investigated in the Third Hospital of Hebei Medical University,totaling 276 cases.SPSS 25.0 was used for statistical analysis.Describe the general information,clinical characteristics,TCM syndrome distribution characteristics of IMN,and the factors affecting TCM syndrome distribution of IMN are further analyzed.Results1.General informationIn 276 cases of IMN,the ratio of male to female was 1.3:1.The average age of onset was 51.07±13.90 years(18-83 years),with 77 cases in the youth group(27.90%),161 cases in the middle-aged group(58.33%),and 38 cases in the elderly group(13.77%).The age difference between male and female patients was not statistically significant.The average BMI was 25.09±3.53,with 7 cases(2.54%)in the lean group,135 cases(48.91%)in the normal group,and 134 cases(48.55%)in the hyperrecombination group.2.Clinical characteristicsAmong the 276 patients with IMN,163 were stage ?(59.06%);105 were stage ?(33.70%);7 were stage ?(1.81%);1 was stage ?(0.36%).61 people(22.10%)were using glucocorticoids,and 215 people(77.90%)were not using glucocorticoids.There were 195 cases(70.65%)in stage 1 CKD,57 cases(20.56%)in stage 2 CKD,18 cases(6.52%)in stage 3 CKD,and 6 cases(2.17%)in stage 4 CKD.The 24-hour urinary protein ration was 4.07±3.53g,24-hour urinary protein ration<3.5g in 151 cases(54.71%),3.5g-8g in 93 cases(33.7%),and>8g in 32 cases(11.59%).Plasma albumin was 31.44±8.41g/L,148 cases(53.62%)with plasma albumin?30g/L,102 cases(36.96%)with plasma albumin between 20?30g/L,plasma albumin?26 cases(9.42%)of 20g/L.The clinical manifestations of nephrotic syndrome were 128 cases(46.3 8%).There were 167 cases with hematuria(62.55%).There were 130 cases(47.10%)with hypertension.There were 35 patients(12.68%)with diabetes mellitus.There were 102 patients with hyperuricemia(37.00%).3.TCM syndrome characteristics(1)Top fifteen symptom frequencyFatigue(89.13%)>Low back pain(85.14%)>Edema(63.04%)>body trapped heavy(54.71%)>Poor sleep(52.54%)>Eat less and don't want to eat(48.55%)>Nocturia more(44.20%)>loose stools(38.77%)=Weak and lazy talk(38.77%)>dry mouth(37.68%)>complexion dark(31.16%)>stomach bilges(28.99%)>complexion sallow(24.28%)>Complexion white(23.91%)and dizziness(23.91%).(2)distribution of sthenia syndrome and asthenia syndromeAmong the 276 cases of IMN,54(19.57%)showed pure deficiency syndrome.There were 30 cases(10.87%)with pure asthenia syndrome.There were 192 cases(69.57%)of local false standard real,false and real inclusion evidence.Among the 54 cases of pure deficiency syndrome,there were 20 cases of spleen-kidney qi deficiency syndrome(37.04%),16 cases of spleen-kidney Yang deficiency syndrome(29.63%),9 cases of liver-kidney Yin deficiency syndrome(16.67%),5 cases of pneumon-kidney qi deficiency syndrome(9.26%),and 2 cases of qi-yin deficiency syndrome.(3.70%).Among the 30 cases in pure empirical study,15(50.00%)had the syndrome of dampness and heat,9(30.00%)had the syndrome of wet stasis,5(16.67%)had the syndrome of water and humidity,and 1(3.33%)had the syndrome of blood stasis.(3)distribution of card of the actual situation mixturThere were a total of 97 cases of spleen-kidney qi deficiency syndrome combined with positive evidence,and 36 cases(37.11%)of spleen-kidney qi deficiency syndrome combined with solid evidence were water-dampness syndrome,followed by 18 cases(18.56%)of blood stasis syndrome,17 cases(17.53%)of dampness and blood stasis syndrome,15 cases(15.46%)of dampness and heat syndrome,and 11 cases(11.34%)of dampness and turbidity syndrome.There were 46 cases of spleen-kidney Yang deficiency syndrome with mixed evidence,and 18 cases(39.13%)with mixed evidence,followed by 12 cases(26.09%).with mixed water dampness syndrome,7 cases(15.22%)with mixed blood stasis syndrome,5 cases(10.87%)with mixed heat syndrome and 4 cases(8.70%)with mixed heat syndrome.There were 25 cases of liver and kidney Yin deficiency syndrome with mixed evidence,10 cases(40.00%)with mixed blood stasis syndrome,8 cases(32.00%)with mixed blood stasis syndrome,3 cases(12.00%)with dampness-heat syndrome,3 cases(12.00%)with dampness and turbidity syndrome,and 1 case(4.00%)with water dampness syndrome.There were 20 cases of syndrome of qi deficiency in lung and kidney,including 7 cases(35.00%)of syndrome of water dampness,6 cases(30.00%)of syndrome of blood stasis,5 cases(25.00%)of syndrome of mutual condensation of dampness and blood stasis,and 2 cases(10.00%)of syndrome of dampness and heat.There were 4 cases of qi and Yin deficiency syndrome and 3 cases of blood stasis syndrome,accounting for 75.00%.There was 1 case(25.00%)with mutual knot syndrome of mixed dampness and stasis.(4)Tongue coating and pulse analysisTongue color:111 cases of pale white tongue(40.22%),followed by 81 cases of dark purple tongue(29.35%),44 cases of red tongue(15.94%),and 40 cases of pale red tongue(14.49%).Tongue shape:93 cases(33.70%)of normal tongue,86 cases(31.16%)of fat tongue(tooth mark),55 cases(19.93%)of ecchyma tongue,30 cases(10.87%)of thin tongue(crack),and 12 cases(4.35%)of punctured tongue.Mosses color:white mosses in 179 cases(64.86%),There were 97 cases of yellow moss(35.14%).Mosses:103 cases(40.94%)of thin mosses,59 cases(21.38%)of thick mosses,55 cases(19.93%)of greasy mosses,44 cases(15.94%)of water slippery mosses,5 cases(1.81%)of dry mosses.Pulse condition:163(59.05%)>acerbity pulse 73(26.45%)>chord pulse 30(10.87%)>slide pulse 22(7.97%)>number pulse 23(8.33%).4.Analysis of factors affecting the distribution of TCM syndromesThe proportion of liver and kidney Yin deficiency syndrome in the 2-year>group was significantly higher than that in the<2-year group(26.39%vs 12.07%),and the difference was statistically significant(P<0.05).The proportion of spleen-kidney qi deficiency in the 24-hour proteinuria>3.5g group was significantly higher than that in the 24-hour proteinuria<3.5g group(56.20%vs 35.19%),showing statistical significance(P<0.05).The proportions of spleen-kidney qi deficiency syndrome(55.15%vs 34.55%)and blood stasis syndrome(31.40%vs 17.82%)in the plasma albumin<30g/L group were significantly higher than those in the>30g/L group,with statistically significant differences(P<0.05).The proportion of excess weight combined with wet stasis syndrome(42.96%vs 19.23%)was significantly higher than that of the normal group,and the difference was statistically significant(P<0.05).The proportion of liver and kidney Yin deficiency syndrome(27.27%vs 13.09%)and lung and kidney qi deficiency syndrome(20.00%vs 7.33%)in the glucocorticoid group was significantly higher than that in the non-glucocorticoid group,showing statistical significance(P<0.05).The proportion of spleen-kidney Yang deficiency syndrome in the group with hypertension was significantly higher than that in the group without hypertension(33.61%vs 15.32%),showing statistical significance(P<0,05).The proportion of liver and kidney Yin deficiency syndrome(21.79%vs 6.67%)and blood stasis syndrome(29.45%vs 10.53%)in the hematuria group was significantly higher than that in the non-hematuria group,showing statistical significance(P<0.05).There were no statistically significant differences in the overall composition of 5 types of deficiency syndrome and 5 types of empirical evidence in gender,age group,CKD stage land 2,and pathological period stage ? and ?.(P>0.05).5.Correlation between TCM syndrome types and clinical factorsSpleen and kidney qi deficiency syndrome has different degree of positive correlation with age,24-hour albuminuria,creatinine,urine red blood cells,total cholesterol,triglyceride,and negative correlation with total protein,albumin,glomerular filtration rate.Spleen kidney yang deficiency has positive correlation with creatinine and negative correlation with glomerular filtration rate.Conclusion1.The TCM syndromes of IMN include deficiency syndrome,positive syndrome and deficiency and solid mixed syndrome,among which deficiency and solid mixed syndrome is the most.In the distribution of deficiency syndrome,spleen and kidney qi deficiency syndrome>spleen and kidney Yang deficiency syndrome>liver and kidney Yin deficiency syndrome>lung and kidney qi deficiency syndrome>qi and Yin deficiency syndrome;In the empirical distribution,the dampness and heat syndrome>and the dampness and blood stasis mutually knot>the water-dampness syndrome>and the blood stasis syndrome.The deficiency of spleen and kidney qi and the deficiency of lung and kidney qi are easy to be combined with the water dampness syndrome,the deficiency of spleen and kidney Yang is easy to be combined with the dampness and turbidity syndrome,the deficiency of liver and kidney Yin and the deficiency of qi and Yin are easy to be combined with the blood stasis syndrome.According to the syndrome characteristics of IMN,this study believes that the basic pathogenesis of this disease is the deficiency of spleen and kidney,and on this basis,the pathological products such as dampness,heat,phlegm,blood stasis and mutual knot of dampness and blood stasis and their clinical manifestations are produced.2.The distribution of TCM syndromes of IMN may be related to the course of disease,24-hour urinary protein quantification,serum albumin,obesity,hormone use,and associated diseases(hypertension,diabetes). |
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