目的：探讨 IgA 肾病病理与中医虚证的关系。方法：多家医院协作的前瞻性研究方法收集数据，对研究对象行肾穿刺活检病理诊断，进行 Hass 分级、牛津分类、Katafuchi 积分和蒋镭评分，同步进行中医虚证辨证分类，分析各病理指数与中医虚证候的关系。结果：HassⅠ~Ⅱ级气虚类和无虚可辨（简称无虚）类相对较多；HassⅢ级气阴两虚类最多；HassⅣ级肝肾阴虚（简称阴虚）类最多；HassⅤ级脾肾阳虚（简称阳虚）类最多。牛津分类中，M1阳虚类最多；S1气阴两虚类最多，其次为阳虚类；E1、T1阳虚类最多，其次为阴虚类；T2阳虚类最多。Katafuchi 总积分阳虚类最高，其后为阴虚类、气阴两虚类；肾小球病变积分包括肾小球增生、球性硬化评分阳虚类高于其他类型，小球节段性病变积分阳虚类和气阴两虚类高于气虚类与无虚类；小管间质病变积分阳虚类高于其他4类、阴虚类高于其余3类；血管病变积分阳虚和阴虚类高于其他3类。蒋镭评分，内皮细胞增生积分阳虚类和阴虚类高于其他3类；破坏血管袢活动性病变积分气阴两虚类高于无虚类。结论：IgA 肾病病理分级、分类及2种病理积分与中医虚证类型具有一定相关性，中医虚证类型一定程度上可以反映 IgA 肾病病理改变程度及预后，对 IgA 肾病中医微观辨证具有参考意义。%Objective:To explore the association between microscopic pathology of IgA nephropathy and deficiency syn-drome classification in Traditional Chinese Medicine(TCM). Methods:A prospective study was used to collect data in multi clinical centers. Patients who were included in the study were performed percutaneous renal biopsy and diagnosed with TCM syndrome type simultaneously. Based on the the pathological diagnosis of biopsy samples,the Hass,Oxford,Katafuchi and Jiang’s classification methods were used to calculate scores to analyze the relationship of deficiency syndrome classification of TCM and pathological indexes of IgA nephropathy. Results:For the Hass level,the patients with qi deficiency and asymptomatic syndrome mostly belonged to grade 1 to 2,the majority of qi and yin deficiency syndrome belonged to grade 3,the patients of liver and kidney yin deficiency mostly be-longed to grade 4 and the patients of spleen and kidney yang deficiency syndrome mostly belonged to grade 5. In the Oxford classifica-tion,the patients of yang deficiency syndrome mostly belonged to the levels of M1、E1、T1 and T2,the patients of qi and yin deficiency syndrome mostly belonged to the levels of S1. In the Katafuchi scoring method,the scores for hyperplasia of glomerular and ball scle-rosis in the patients of yang deficiency syndrome were all apparently higher than other types. The glomerular segmental lesions scores for the patients of yang deficiency and qi - yin deficiency syndrome were both higher than scores for qi deficiency and asymptomatic syndrome. The tubular interstitial lesion score for the patients of yang deficiency was higher than other four types,and also was higher than other three types for the patients of yin deficiency syndrome. The scores for vasculopathy in the patients of yang deficiency and yin deficiency syndrome were both higher than other types. In the Jiang’scoring method showed that the endothelial cell proliferation score was higher in patients of yang deficiency and yin deficiency than in those of the other three types. The scores for destruction of vascular loops active lesions in patients of qi and yin deficiency were all higher than in asymptomatic patients. Conclusion:The defi-ciency syndrome classification in TCM of IgA nephropathy show apparent rule in renal pathology classification and pathological indica-tors,and also indicate the change in pathology and prognosis of IgA nephropathy to a certain extent,which could provide some refer-ence for of IgA nephropathy.
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