The Characteristics Of TCM Syndrome Types Distribution Of The Renal Damage Caused By ANCA-associated Systemic Vasculitis(AASV) And The Correlation Analysis Between AASV And Laboratory Results And Renal Pathological Indexes

ObjectiveTo explore the characteristics of TCM syndrome types distribution of the renal damage caused by ANCA-associated systemic vasculitis(AASV),and the correlation between AASV and laboratory results and renal pathological indexes,to enrich the basis of treatment based on syndrome differentiation of TCM and to provide basis for AASV renal damage condition assessment.Methods A retrospective analysis was used in this research.90 patients diagnosed with AASV joint renal damage were selected from Hangzhou Traditional Chinese Medical Hospital between January 2010 and February 2015,among them there were 30 patients had underwent renal biopsy and had full pathological data during the hospitalized time.Collect the clinical data,laboratory examination results and renal biopsy pathology data of the selected cases.According to the collected four diagnostic data of TCM,referring to the related literature and opinions from kidney disease experts,formulate TCM syndrome differentiation standards of AASV renal damage,according to which the standard syndrome differentiation types were as follows:deficiency syndrome,turbidity stasis syndrome,and wind-dampness syndrome,and according to the situation of diseases and syndromes,90 cases were divided into 4 groups to study,they were pure deficiency syndrome group,deficiency+turbidity stasis syndrome group,deficiency+wind-dampness syndrome group,and deficiency+turbidity stasis+wind-dampness syndrome group.Use SPSS 19.0 statistical software to analyze the relationship between the TCM syndrome type grouping and distribution characteristics of different types,the clinical data,laboratory examination results,and renal biopsy pathological indexes.Results(1)The clinical data and the distribution and grouping of TCM syndrome types of AASV renal damage patients:in the 90 cases,41 cases were men,49 cases were women,ratio of male to female was 1:1.2,their average age was 59.83±13.88.Different distribution and grouping of TCM syndrome types grouped by frequency from high to low were deficiency+turbidity stasis syndrome(54 cases),deficiency+wind-dampness syndrome(15 cases),deficiency+turbidity stasis+wind-dampness syndrome(13 cases),pure deficiency syndrome(8 cases),and the results showed deficiency syndrome existed in the whole course of AASV renal damage.But rarely had cases of pure deficiency syndrome(8 cases)and the most numerous cases were joint with turbidity stasis syndrome(67 cases),and followed by patients joint with wind-dampness syndrome(28 cases).The average course of disease was 6 months,and from long to short were pure deficiency syndrome,deficiency-1-turbidity stasis syndrome,deficiency+turbidity stasis+wind-dampness syndrome and deficiency+wind-dampness syndrome which speculating that the most likely early syndrome of AASV renal damage disease is wind-dampness syndrome,later move on to turbidity stasis syndrome,and finally becomes pure deficiency syndrome.(2)Laboratory examination results of AASV patients with renal damage:positive rate of urine protein all patients with AASV renal damage was 91.11%,and quantitative average of the urine protein was 1.58±1.34g/24h.The percentage of patients with higher serum creatinine reaches 86.67%,and the average serum creatinine level was 476.10±332.01μmol/L.Between different groups with different syndrome types of TCM,the 24h highest average quantitative level of urinary protein and serum creatinine was deficiency+turbidity stasis+wind-dampness syndrome group.anemia rate among all AASV renal damage patients reached 95.56%,and the average haemoglobin was 84.37± 16.12g/L.It’s more apparent of anemia in deficiency+turbidity stasis+wind-dampness syndrome group between different groups.Blood CRP was significantly increased in all AASV renal damage patients.Between each groups,the blood CRP was highest in deficiency+wind-dampness syndrome group,and it was lowest in pure deficiency syndrome group.(3)Renal pathological features of AASV renal damage patients:in 30 cases who underwent renal biopsy,patients with pauci immune deposits(immunofluorescence≤1+)took up(73.33%);up to 93.33%of patients suffered glomerular sclerosis,and the average level was 25.35±18.23%;the average percentage of crescent formation was 56.77±22.17%,and most of them(76.16%)were big crescents;capillary loops necrosis appeared in 63.3%of patients;baumann’s capsule of 46.7%of patients ruptured;up to 36.67%of patients were with renal tubular necrosis;the pathological performance above were in accordance with characteristics as "pauci immune deposits,necrotizing crescent nephritis".Between groups of different TCM syndrome types,degree of glomerular sclerosis increased in deficiency+wind-dampness syndrome group,deficiency+turbidity stasis+wind-dampness syndrome group,deficiency+turbidity stasis syndrome group.and the average proportion of cellular crescents increased in deficiency+turbidity stasis syndrome group,deficiency+turbidity stasis+wind-dampness syndrome group,deficiency+wind-dampness syndrome group.In almost all cases of renal biopsy,varying degrees of glomerular sclerosis,renal tubular atrophy and renal interstitial fibrosis and chronic performance were detected,so we speculated that wind-dampness syndrome represents the acute performance in AASV renal damage,the turbidity stasis syndrome represents the relative chronic performance and deficiency syndrome represents the chronic performance.Compared to the pure deficiency syndrome,patients merged with wind-dampness syndrome were of more active lesions in renal pathological activity,patients merged with turbidity stasis syndrome were of more chronic lesions in renal pathological activity.(4)BVAS integral characteristics of each groups:BVAS integral order from high to low was:deficiency+wind-dampness syndrome,deficiency+turbidity stasis+wind-dampness syndrome,deficiency+turbidity stasis syndrome and pure deficiency syndrome,then suggesting that the disease activity of each syndrome type of TCM from high to low is:deficiency+wind-dampness syndrome,deficiency+turbidity stasis+wind-dampness syndrome,deficiency+turbidity stasis syndrome and pure deficiency syndrome,which is in accordance with disease activity judged from the laboratory examination results and renal biopsy pathological indexes.Conclusion(1)To investigate the distribution of the syndrome type of TCM in AASV renal damage disease,the results showed deficiency syndrome existed in the whole course of AASV renal damage.But rarely had cases of pure deficiency syndrome and many cases had deficiency syndrome joint with turbidity stasis syndrome and wind-dampness syndrome,and the most numerous cases were joint with turbidity stasis syndrome,and followed by patients joint with wind-dampness syndrome,which is another syndrome type of AASV renal damage.(2)In the observation of laboratory examination results and renal biopsy pathological indexes we found:it’s more apparent of anemia and renal function damage in deficiency+turbidity stasis+wind-dampness syndrome group between different groups;the blood CRP increased more obviously in deficiency+wind-dampness syndrome group;turbidity stasis syndrome group had the highest degree of glomerular sclerosis,and the average proportion of cellular crescents in deficiency+turbidity stasis syndrome group was highest,suggesting that wind-dampness syndrome represents the acute lesion in AASV renal damage,the turbidity stasis syndrome represents the relative chronic lesion and deficiency syndrome joint with wind-dampness syndrome and turbidity stasis syndrome represents the most serious damage stage of AASV renal damage disease and it has certain guiding significance in AASV renal damage syndrome differentiation of TCM in clinical.(3)BVAS integral order from high to low was:deficiency+wind-dampness syndrome group,deficiency+turbidity stasis+wind-dampness syndrome group,deficiency+turbidity stasis syndrome group and pure deficiency syndrome group,then suggesting that the disease activity of each syndrome type of TCM from high to low is:deficiency+wind-dampness syndrome group,deficiency+turbidity stasis+wind-dampness syndrome group,deficiency+turbidity stasis syndrome group and pure deficiency syndrome group,which is in accordance with disease activity judged from the laboratory examination results and renal biopsy pathological indexes.