| Research backgroundIgA Nephropathy(IgAN)is a kind of glomerular disease characterized by IgA or IgA-dominated immune complexes deposited in the mesangial area or capillary wall of the glomerulus.Its clinical manifestations are varied,mainly manifested as hematuria,accompanied by varying degrees of proteinuria,hypertension and impaired renal function.It is the most common primary glomerular disease worldwide,with 20%-40%of patients with IgA nephropathy progressing to end-stage renal disease(end-stage renal diseases,ESRD)within 20 years.Although the main clinical manifestation of IgAN is hematuria,few studies have involved the relationship between persistent microscopic hematuria and clinical,pathological,and TCM syndromic symptoms.In this study,a cross-sectional retrospective study was conducted to investigate the correlation between persistent microscopic hematuria and TCM syndromes and clinicopathology of IgA nephropathy.ObjectiveTo investigate the TCM syndromes,clinical and pathological features of IgA nephropathy with persistent microscopic hematuria.MethodsA retrospective cross-sectional study was conducted to collect patients with IgA nephropathy confirmed by renal biopsy in our department from January 2013 to June 2020 based on the IgA nephropathy database of Guang 'anmen Hospital,China Academy of Chinese Medical Sciences.According to whether accompanied by persistent endoscopic hematuria(mean urinary erythrocyte count ? 5/HP at high magnification 6 months before renal puncture),the included 226 patients were divided into persistent microscopic hematuria group and non-persistent microscopic hematuria group.The general data,clinical data,pathological data and TCM syndromes data of the two groups were collected.To investigate the TCM syndromes,clinical and renal pathological features of IgA nephropathy patients with persistent microscopic hematuria.Results1.General Information1.1 IncorporationA total of 226 patients were included,including 147 cases(65.0%)in the persistent microscopic hematuria group and 79 cases(35.0%)in the non-persistent microscopic hematuria group.1.2 GenderThere were 79 males(53.7%)and 68 females(46.3%)in the persistent microscopic hematuria group,and 49 males(62.0%)and 30 females(38%)in the non-persistent microscopic hematuria group.Male patients were more common in both groups,and the difference was not statistically significant(P>0.05).1.3 Age of renal biopsyAll the patients included in the study ranged in age at renal biopsy from 16 to 78 years old,with an average age of 39.46 ± 12.52 years old.The average age of renal biopsy in the persistent microscopic hematuria group and the non-persistent microscopic hematuria group was 38.56 ± 13.06 years old vs 41.14 ± 11.35 years old,which was roughly the same between the two groups.The difference was not statistically significant(P>0.05).The age of renal biopsy was divided into four ages:<18 years old,18-40 years old,41?65 years old,and>65 years old.The results showed that most patients in this study were in the age group of 18-40 years old,and there was no statistical significance in the difference(P>0.05).1.4 Course of diseaseThe median course of disease was 12.0(37.0)months in the persistent microscopic hematuria group and 27.0(67.0)months in the non-persistent microscopic hematuria group,and there was no statistical significance between the two groups(P>0.05).1.5 BMIThe median BMI of all patients included in the study was 24.51(5.18)kg/m2,and the median BMI of the persistent microscopic hematuria group and the non-persistent microscopic hematuria group was 24.61(4.98)kg/m2 vs 24.22(5.34)kg/m2,with no statistically significant difference between the two groups(P>0.05).BMI was divided into three groups:<18.5 kg/m2,18.5?27.9 kg/m2 and ? 28 kg/m2,and there was no statistically significant difference(P>0.05).2 Information of Traditional Chinese MedicineComparison of main syndromes in acute attack stage between persistent microscope hematuria group and non-persistent microscope hematuria group:exogenous wind-heat syndrome(12.2%vs 5.1%)and lower coke damp-heat syndrome(4.1%vs 5.1%),there was no statistical significance between the two groups(P>0.05).Comparison of main symptoms in chronic remission stage:lung and spleen qi deficiency syndrome(32.0%vs 34.2%),spleen-kidney Yang deficiency syndrome(13.6%vs 22.8%),qi and Yin deficiency syndrome(23.1%vs 15.2%),liver and kidney Yin deficiency syndrome(15.0%vs 17.7%);Simultaneous comparison:no concurrent syndrome(19.0%vs 15.2%),blood stasis(34%vs 40.5%),dampness and heat(25.2%vs 25.3%),water dampness(6.8%vs 8.9%),turbidity toxicity(6.8%vs 5.1%),phlegm dampness(6.1%vs 3.8%),cold dampness(1.4%vs 1.3%),liver depression(0.7%vs 0%),and there was no statistical significance in the comparison of main syndrome and concurrent syndrome between the two groups(P>0.05).3 Clinical indicators3.1 high blood pressureThe incidence of hypertension was 72.8%vs 69.6%in the persistent microscope hematuria group and the non-persistent microscope hematuria group,among which,the proportion of hypertension grade 1 was 34%vs 19%,the proportion of hypertension grade 2 was 10.2%vs 21.5%,and the proportion of hypertension grade 3 was 28.6%vs 29.1%.The difference was statistically significant(P<0.05).The incidence of hypertension was relatively low in the group with persistent microscopic hematuria.3.2 24-hour urinary total proteinComparison of persistent microscope hematuria group and non-persistent microscope hematuria group:the median 24h-UTP was 1.728(2.036)g/24h vs 1.648(2.486)g/24h,respectively,and there was no statistical significance between the two groups(P>0.05).3.3 Renal functionThe median of CR was 94.5(70.0)vs 102.0(71.0)?mol/L,P>0.05 in the persistent microscope hematuria group and the non-persistent microscope hematuria group.The median value of BUN was[6.0(3.0)vs 6.2(3.0)]mmol/L.The median eGFR was[70.84(49.00)vs 67.72(40.48)]ml·min-1·1.73m-2,P>0.05,and there was no statistical significance between the two groups.3.4 CKD stageThe proportion of CKD stage in the persistent microscope hematuria group and the non-persistent microscope hematuria group was:Stage 1(29.9%vs 20.3%),Stage 2(35.4%vs 36.7%),Stage 3A(13.6%vs 20.3%),Stage 3B(10.9%vs 15.2%),Stage 4(7.5%vs 6.3%),Stage 5(2.7%vs 1.3%),The difference was not statistically significant(P>0.05).3.5 Blood fatComparison of the median of various lipid indexes between the persistent microscope hematuria group and the non-persistent microscope hematuria group:TC(4.88 vs 5.06)mmol/L,TG(1.73 vs 2.00)mmol/L,HDL-C(1.13 vs 1.17)mmol/L,LDL-C(2.95 vs 3.14)mmol/L,The indexes of blood lipid in the persistent microscope hematuria group were lower than those in the non-persistent microscope hematuria group,but there was no statistical signifi cance between the two groups(P>0.05).3.6 Other laboratory indicatorsComparison between the persistent microscope hematuria group and the non-persistent microscope hematuria group:the median HGB was 135.00(29.00)g/L vs 142.0(28.00)g/L,respectively,and the difference was statistically significant(P<0.05).There were no significant differences in HCO3-,ALB,UA,serum IgA,serum IgM,complement C3,complement C4 and other indexes between the two groups(P>0.05).4 Pathological indicators4.1 Oxford pathological classificationComparison of the incidence of each pathological index between the persistent microscope hematuria group and the non-persistent microscope hematuria group:hyperplasia of mesangial cells(83%vs 74.7%),proliferation of capillary endothelial cells(35.4%vs 22.8%),segmental glomerulosclerosis or adhesion(59.2%vs 69.8%),renal tubule atrophy/interstitial fibrosis(64.6%vs 53.2%),crescent(66.0%vs 45.6%).The incidence of crescent in the persistent microscope hematuria group was significantly higher than that in the non-persistent microscope hematuria group(P<0.01),and there was no significant difference in the other indicators between the two groups(P>0.05).4.2 ImmunofluorescenceIgA+IgM+C3[77 cases(52.4%)vs 34 cases(43.0%)]and IgA+C3[47 cases(32.0%)vs 27 cases(34.2%)]were the two types of immune complex with the highest proportion in the persistent microscope hematuria group and the non-persistent microscope hematuria group.There was no significant difference between the two groups(P>0.05).IgA deposition was found in both the persistent microscope hematuria group and the non-persistent microscope hematuria group.Comparison of the immunofluorescence intensity:1+(6.8%vs 19.0%),2+(30.6%vs 40.5%),and 3+(62.6%vs 40.5%)had significant(P<0.01).The IgA deposition intensity and deposition rate in the persistent microscope hematuria group were higher than those in the non-persistent microscope hematuria group.The deposition rate of IgM in the persistent microscopic hematuria group and the non-persistent microscopic hematuria group was 63.9%and 54.4%,respectively.Comparison of the immunofluorescence intensity:0+(36.1%vs 45.6%),1+(53.1%vs 36.7%),2+(10.9%vs 16.5%)and 3+(0.0%vs 1.3%)were statistically significant(P<0.05).The deposition intensity and deposition rate of IgM in the persistent microscopic hematuria group were higher than those in the non-persistent microscopic hematuria group.The C3 deposition rate of the persistent microscope hematuria group and the non-persistent microscope hematuria group was 95.2%and 86.1%,respectively.Comparison of the immunofluorescence intensity:0+(4.8%13.9%),1+(20.4%vs 27.8%),2+(45.6%vs 34.2%),3+(29.3%vs 24.1%),The difference was statistically significant(P<0.05).The C3 deposition intensity and deposition rate in the persistent microscope hematuria group were higher than those in the non-persistent microscope hematuria group.There was no significant difference in IgG,C1q,FRA and ALB between the two groups(P>0.05).The deposition of IgA,IgM and C3 was more obvious when accompanied by persistent hematuria IgA nephropathy under microscope.Conclusion(1)The distribution of TCM syndromes of IgA nephropathy with persistent microscope hematuria was basically the same,indicating that there was no significant correlation between TCM syndromes of IgA nephropathy with persistent microscope hematuria;(2)The incidence of hypertension and HGB level in IgA nephropathy with persistent microscope hematuria were relatively low,the incidence of crescent was higher,and the deposition of IgA,IgM and C3 was more obvious,suggesting that persistent microscope hematuria may be a risk factor affecting the prognosis of IgA nephropathy. |
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