IgA肾病中医证型与黏膜免疫相关性横断面研究

作者	单位
成庭柱;任翼;杜亚婷;冯雪;孙士鹏;饶向荣;李深	1.中国中医科学院广安门医院肾病科（北京 100053）,2. 首都医科大学附属北京友谊医院中医科（北京 100050）,3. 中国中医科学院广安门医院检验科（北京 100053）

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中文摘要:

目的探讨IgA肾病（IgAN）患者中医证候分型及与黏膜免疫的相关性。方法采用横断面研究方法，纳入IgAN患者410例，收集患者中医证候资料，运用因子分析及聚类分析方法，总结中医证候分类。对其中118例患者血清低半乳糖基化IgA1（Gd-IgA1）及黏膜免疫相关标志物：B细胞活化因子（BAFF）、增殖诱导配体（APRIL）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）进行检测，分析不同中医证候患者血清Gd-IgA1含量及其与上述黏膜免疫相关标志物的相关性。结果共采集51个与IgAN证候紧密相关的症状、舌象及脉象，提取13个特征根>1的公因子，聚类为4类。将IgAN患者的中医证候归类为肺脾气虚证186例（45.36%），肝肾阴虚证102例（24.88%），脾肾阳虚证79例（19.27%），肝气郁滞证43例（10.49%）。肺脾气虚证患者Gd-IgA1含量为6.09（4.44，7.00）μg/mL，高于其他中医证型患者（P＜0.01）。伴有不同部位黏膜炎症的IgAN患者Gd-IgA1含量较不伴有黏膜炎症的患者升高（P＜0.01）。IgAN患者Gd-IgA1含量与黏膜免疫相关标志物APRIL、IL-6、TNF-α具有相关性（P＜0.05）。结论 IgAN患者临床常见证型为肺脾气虚证、肝肾阴虚证、脾肾阳虚证、肝气郁滞证，肺脾气虚证与黏膜免疫异常关系最密切。

英文摘要:

Objective To explore the Chinese medicine（CM） syndrome classification and its correlation with mucosal immunity in patients with IgA nephropathy（IgAN）. Methods A cross-sectional study was performed，including 410 patients with IgAN. The data of CM syndrome were collected，and the CM syndrome classification was summarized by factor analysis and cluster analysis. Serum levels of galactose-deficient IgA1（Gd-IgA1）and mucosal immune-related markers，including B cell activating factor（BAFF），a proliferation inducing ligand（APRIL），interleukin-6（IL-6） and tumor necrosis factor-α（TNF-α）were measured in 118 patients. The correlation between serum Gd-IgA1 levels in different CM syndromes and these mucosal immune-related markers was analyzed. Results A total of 51 symptoms，tongue images and pulse images closely related to IgAN syndromes were collected，and 13 common factors with eigenvalues greater than 1 could be extracted，which could be clustered into 4 categories. The CM syndromes of IgAN patients were classified as Fei-Pi qi-deficiency syndrome in 186 cases（45.36%），Gan-Shen yin-deficiency syndrome in 102 cases（24.88%），Pi-Shen yang-deficiency syndrome in 79 cases（19.27%），and Gan qi depression syndrome in 43 cases（10.49%）. The serum Gd-IgA1 levels of patients with Fei-Pi qi-deficiency syndrome was 6.09（4.44，7.00）μg/mL，which was significantly higher than that of patients with other CM syndromes（P<0.01）.Gd-IgA1 levels were elevated in patients with IgAN at different sites of mucosal inflammation compared with patients without mucosal inflammation（P<0.01）. Serum Gd-IgA1 levels in IgAN patients demonstrated correlations with mucosal immune-related markers APRIL，IL-6 and TNF-α（P<0.05）. Conclusions The prevalent clinical CM syndromes in IgAN patients are Fei-Pi qi-deficiency syndrome，Gan-Shen yin deficiency syndrome，Pi-Shen yang-deficiency syndrome，and Gan qi depression syndrome. Fei-Pi qi-deficiency syndrome is most closely associated with abnormal mucosal immunity in IgAN.

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