本文關(guān)鍵詞： IgAN 足細胞 牛津病理分型 中醫(yī)證型　出處：《浙江中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的通過研究IgAN尿液足細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,為正確認識和評價IgAN的疾病狀態(tài)、判斷病情進展及改善預(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,其中足細胞陽性60例,足細胞陰性60例。對所有IgAN研究病例按照統(tǒng)一設(shè)計的表格進行相關(guān)臨床資料、實驗室指標、中醫(yī)證型的采集與整理,應(yīng)用SPSS17.0軟件對數(shù)據(jù)進行統(tǒng)計學處理,分析尿液足細胞與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胞陽性組與足細胞陰性兩組,比較兩組的臨床、實驗室、牛津病理指標發(fā)現(xiàn)足細胞陽性組24小時蛋白定量、血肌酐、血尿酸、鏡下紅細胞百分比高于足細胞陰性組,血清白蛋白、估算腎小球濾過率、內(nèi)生肌酐清除率、尿滲透壓低于足細胞陰性組,足細胞陽性組腎功能不全發(fā)生率高于足細胞陰性組,差異具有統(tǒng)計學意義(P0.05)。同時,足細胞陽性組中毛細血管內(nèi)皮細胞增生(E)、節(jié)段粘連或硬化(S)、間質(zhì)纖維化或腎小管萎縮(T)百分比高于足細胞陰性組,差異具有統(tǒng)計學意義(P0.05)。2、Logistic回歸結(jié)果顯示尿足細胞、平均動脈壓與發(fā)生腎功能不全正相關(guān),接近顯著性統(tǒng)計學意義(P=0.071,P=0.053)。3、對足細胞兩組中醫(yī)證型進行比較發(fā)現(xiàn),足細胞陽性組總風濕證型(包括風濕一聯(lián)證、風濕二聯(lián)證、風濕三聯(lián)證、風濕四聯(lián)證)所占比例最高,但證型單獨分析后發(fā)現(xiàn)足細胞陽性組風濕瘀痹證最多見,風濕瘀痹證風濕證腎虛瘀痹證,足細胞陰組則以腎虛瘀痹證最多見,腎虛瘀痹證腎虛證風濕瘀痹證。足細胞陽性組總風濕證的發(fā)生率高于足細胞陰性組,差異具有統(tǒng)計學意義(P0.05)。4、將入組患者分為風濕證組和非風濕證組兩組,發(fā)現(xiàn)風濕證組中毛細血管內(nèi)皮細胞增生(E)、節(jié)段粘連或硬化(S)、間質(zhì)纖維化或腎小管萎縮(T)、動脈積分(A)百分比高于非風濕證組,差異有統(tǒng)計學意義(P0.05)。結(jié)論尿足細胞陽性IgAN患者的腎損傷及腎臟病理改變更重,尿足細胞陽性與IgAN風濕內(nèi)擾證密切相關(guān),風濕證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.
【學位授予單位】：浙江中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R277.5

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