本文關(guān)鍵詞： IgAN 足細(xì)胞 牛津病理分型 中醫(yī)證型　出處：《浙江中醫(yī)藥大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的通過(guò)研究IgAN尿液足細(xì)胞與牛津病理分型及中醫(yī)證型的相關(guān)性,優(yōu)化IgAN的中醫(yī)辨證體系,為正確認(rèn)識(shí)和評(píng)價(jià)IgAN的疾病狀態(tài)、判斷病情進(jìn)展及改善預(yù)后提供客觀依據(jù)。方法選取在杭州市中醫(yī)院經(jīng)腎活檢提示為原發(fā)性的IgAN患者共120例,其中足細(xì)胞陽(yáng)性60例,足細(xì)胞陰性60例。對(duì)所有IgAN研究病例按照統(tǒng)一設(shè)計(jì)的表格進(jìn)行相關(guān)臨床資料、實(shí)驗(yàn)室指標(biāo)、中醫(yī)證型的采集與整理,應(yīng)用SPSS17.0軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理,分析尿液足細(xì)胞與IgAN牛津病理分型的關(guān)系,分析不同中醫(yī)證型IgAN與尿液足細(xì)胞的關(guān)系,分析IgAN不同中醫(yī)證型與牛津病理分型的關(guān)系,最后整合分析尿液足細(xì)胞數(shù)、牛津病理分型和中醫(yī)證型三者之間的相關(guān)性。結(jié)果1、將入組患者分成尿足細(xì)胞陽(yáng)性組與足細(xì)胞陰性?xún)山M,比較兩組的臨床、實(shí)驗(yàn)室、牛津病理指標(biāo)發(fā)現(xiàn)足細(xì)胞陽(yáng)性組24小時(shí)蛋白定量、血肌酐、血尿酸、鏡下紅細(xì)胞百分比高于足細(xì)胞陰性組,血清白蛋白、估算腎小球?yàn)V過(guò)率、內(nèi)生肌酐清除率、尿滲透壓低于足細(xì)胞陰性組,足細(xì)胞陽(yáng)性組腎功能不全發(fā)生率高于足細(xì)胞陰性組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。同時(shí),足細(xì)胞陽(yáng)性組中毛細(xì)血管內(nèi)皮細(xì)胞增生(E)、節(jié)段粘連或硬化(S)、間質(zhì)纖維化或腎小管萎縮(T)百分比高于足細(xì)胞陰性組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。2、Logistic回歸結(jié)果顯示尿足細(xì)胞、平均動(dòng)脈壓與發(fā)生腎功能不全正相關(guān),接近顯著性統(tǒng)計(jì)學(xué)意義(P=0.071,P=0.053)。3、對(duì)足細(xì)胞兩組中醫(yī)證型進(jìn)行比較發(fā)現(xiàn),足細(xì)胞陽(yáng)性組總風(fēng)濕證型(包括風(fēng)濕一聯(lián)證、風(fēng)濕二聯(lián)證、風(fēng)濕三聯(lián)證、風(fēng)濕四聯(lián)證)所占比例最高,但證型單獨(dú)分析后發(fā)現(xiàn)足細(xì)胞陽(yáng)性組風(fēng)濕瘀痹證最多見(jiàn),風(fēng)濕瘀痹證風(fēng)濕證腎虛瘀痹證,足細(xì)胞陰組則以腎虛瘀痹證最多見(jiàn),腎虛瘀痹證腎虛證風(fēng)濕瘀痹證。足細(xì)胞陽(yáng)性組總風(fēng)濕證的發(fā)生率高于足細(xì)胞陰性組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4、將入組患者分為風(fēng)濕證組和非風(fēng)濕證組兩組,發(fā)現(xiàn)風(fēng)濕證組中毛細(xì)血管內(nèi)皮細(xì)胞增生(E)、節(jié)段粘連或硬化(S)、間質(zhì)纖維化或腎小管萎縮(T)、動(dòng)脈積分(A)百分比高于非風(fēng)濕證組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論尿足細(xì)胞陽(yáng)性IgAN患者的腎損傷及腎臟病理改變更重,尿足細(xì)胞陽(yáng)性與IgAN風(fēng)濕內(nèi)擾證密切相關(guān),風(fēng)濕證IgAN患者的腎臟病理改變更重。
[Abstract]:Objective to optimize the TCM syndrome differentiation system of IgAN by studying the correlation between urinary podocytes of IgAN and Oxford pathological classification and TCM syndromes, so as to correctly understand and evaluate the disease status of IgAN. Methods 120 patients with primary IgAN were selected by renal biopsy in Hangzhou traditional Chinese Medicine Hospital, 60 of them were podocyte positive. 60 cases of podocyte negative. According to the unified design of the table, all cases of IgAN were collected and sorted according to the unified design of clinical data, laboratory indicators, TCM syndromes, and the data were statistically processed by SPSS17.0 software. The relationship between urinary podocyte and IgAN Oxford pathological classification, the relationship between different TCM syndromes IgAN and urinary podocyte, and the relationship between different IgAN TCM syndromes and Oxford pathological typing were analyzed. Finally, the number of urinary podocytes was analyzed. Results 1. The patients were divided into two groups: positive urine podocyte group and podocyte negative group. Oxford pathological markers showed that 24 hours protein quantification, serum creatinine, uric acid, erythrocyte percentage under microscope were higher in podocyte positive group than in podocyte negative group, serum albumin, estimated glomerular filtration rate, endogenous creatinine clearance rate. The incidence of renal insufficiency in podocyte positive group was higher than that in podocyte negative group (P 0.05). In podocyte positive group, the percentage of capillary endothelial cell proliferation, segmental adhesion or sclerosis, interstitial fibrosis or renal tubular atrophy was higher than that of podocyte negative group, and the difference was statistically significant (P 0.05). Logistic regression analysis showed that urinary podocyte. The mean arterial pressure was positively correlated with renal insufficiency, which was close to significant statistical significance (P < 0.071). The TCM syndrome types of podocyte were compared between the two groups. The total rheumatism syndrome types (including rheumatism combined syndrome, rheumatism combined syndrome, rheumatism triple syndrome) were found in podocyte positive group, and there were three syndromes in podocyte positive group, including rheumatism syndrome, rheumatism syndrome and rheumatism syndrome. The proportion of rheumatism combined syndrome was the highest, but the syndrome type was found to be the most common in podocyte positive group, rheumatic stasis syndrome, rheumatism syndrome, kidney deficiency syndrome and arthralgia syndrome in podocyte yin group, but the syndrome of kidney deficiency and stasis arthralgia was the most common syndrome in podocyte positive group. The incidence of total rheumatism in podocyte positive group was higher than that in podocyte negative group. It was found that the percentage of capillary endothelial cell proliferation, segmental adhesion or sclerosing, interstitial fibrosis or renal tubule atrophy in rheumatic syndrome group was higher than that in non-rheumatic syndrome group. Conclusion the renal injury and renal pathological changes of IgAN patients with positive uropoda cells are more serious. The positive of urinary podocytes is closely related to the internal disturbance of IgAN rheumatism, and the renal pathological changes of IgAN patients with rheumatic syndrome are more serious.
【學(xué)位授予單位】：浙江中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R277.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 唐英;蔣宇鋒;鄒峗;張昕賢;何立群;;IgA腎病足細(xì)胞損傷機(jī)制及中醫(yī)藥治療的研究進(jìn)展[J];中國(guó)中西醫(yī)結(jié)合腎病雜志;2016年08期

2 蔡麗麗;余瑾;李亞妤;俞東容;;尿足細(xì)胞與IgA腎病風(fēng)濕證的相關(guān)性研究[J];中國(guó)現(xiàn)代醫(yī)生;2016年14期

3 黃威;王偉銘;;新型免疫抑制劑在IgA腎病治療中的應(yīng)用及研究進(jìn)展[J];上海交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2015年11期

4 王楠楠;卜茹;蔡廣研;陳香美;;IgA腎病相關(guān)尿液無(wú)創(chuàng)性生物標(biāo)志物的研究進(jìn)展[J];中華腎病研究電子雜志;2015年02期

5 邵命海;卓鵬偉;彭培初;;彭培初辨治IgA腎病經(jīng)驗(yàn)探析[J];上海中醫(yī)藥雜志;2015年04期

6 姜飛;俞東容;蔡麗麗;;IgA腎病預(yù)后危險(xiǎn)因素研究進(jìn)展[J];中國(guó)中西醫(yī)結(jié)合腎病雜志;2014年11期

7 黃蘭;趙亞娟;劉艷紅;劉俊英;郭風(fēng)玲;胡桂才;;原發(fā)性IgA腎病病理分級(jí)方法比較[J];河北醫(yī)學(xué);2014年04期

8 陳迪;趙丹妮;何靈芝;;何靈芝主任辨治IgA腎病經(jīng)驗(yàn)[J];浙江中醫(yī)藥大學(xué)學(xué)報(bào);2014年02期

9 李利利;楊浩杰;張文靜;尹愛(ài)平;孫吉平;;尿脫落足細(xì)胞與IgA腎病的相關(guān)性研究[J];西安交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2014年02期

10 夏楠楠;劉章鎖;;102例IgA腎病蛋白尿與病理臨床分析[J];中國(guó)實(shí)驗(yàn)診斷學(xué);2013年06期

，

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