Page 71 - 2022-27-中国全科医学

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Corresponding author：CHEN Xiangmei，Professor，Chief physician；E-mail：xmchen@126.com
【Abstract】 Background IgA nephropathy（IgAN） is the most common primary glomerular disease，and one major
cause of malignant hypertension（MHT） secondary to renal parenchymal disease. The clinical conditions and severity of renal
lesion have been reported to be more serious when IgAN is accompanied by MHT，but risk factors of MHT in IgAN analyzed
from Traditional Chinese Medicine（TCM）perspective are still unclear. Objective To explore the TCM-related factors and
pathogenesis associated with MHT in IgAN patients. Methods From 518 cases of primary IgAN who were diagnosed by renal
biopsy in First Medical Center of Chinese PLA General Hospital during December 2013 to September 2021，a sample of 12 cases
accompanied by MHT（IgAN-MHT group） computed by PASS 15.0 were selected for correlation power analysis，and they
were matched at a ratio of 1∶5 with other randomly selected 85 cases without MHT（IgAN group）. Clinical，pathological and
TCM syndromes between the two groups were compared. Lasso regression was used to screen 93 TCM syndromes，among which
those with significant associations with IgAN-MHT were identified by multivariate Logistic regression. Results Compared with
IgAN group，IgAN-MHT group had higher prevalence of headache and dizziness or nausea and vomiting as the first clinical
manifestations，and clinically diagnosed nephrotic syndrome，higher levels of baseline mean arterial pressure，highest systolic
and diastolic blood pressure，blood urea nitrogen，serum creatinine，serum inorganic phosphorus，serum magnesium，and
quantitatively estimated 24-hour urinary protein excretion，higher prevalence of CKD stages 3-5，blood stasis syndrome，
subtypes of qi-deficiency syndromes（including mental fatigue and lack of strength，limb fatigue，tibia and leg weakness，
dizziness，headache with nausea，and vomiting），subtypes of yin-deficiency syndromes（including blurred vision and
eye floaters），subtypes of blood stasis syndromes（including nail cyanosis，and dark purple tongue），and intrarenal
arteriosclerosis（P<0.05）. Moreover，IgAN-MHT group had lower prevalence of abnormal urine test results as the first clinical
manifestations，previous hypertension and clinical diagnosed chronic nephritic syndrome，as well as lower levels of mean
serum IgM and IgG levels，and eGFR（P<0.05）. Both groups had no significant difference in the prevalence of interstitial
fibrosis/tubular atrophy（T） lesions among the two groups（P<0.05）. The common TCM syndrome in IgAN-MHT group was
qi-yin deficiency syndrome combined with blood stasis syndrome. Correlation analysis showed that IgAN-MHT was positively
associated with blood stasis syndrome（P<0.05）；in IgAN-MHT group，male and quantitatively estimated 24-hour urinary
protein excretion was positively associated with qi-deficiency syndrome（P<0.05）；serum inorganic phosphorus and potassium
was negatively associated with yin-deficiency syndrome（P<0.05），and renal tubular atrophy/interstitial fibrosis was positively
associated with blood stasis syndrome （P=0.040）. Multivariate Logistic regression analysis showed that headache〔OR=7.895，
95%CI（1.643，37.935），P=0.010〕，blurred vision〔OR=5.499，95%CI（1.207，25.053），P=0.028〕，dry mouth
with desire for drink 〔OR=10.079，95%CI（2.289，44.373），P=0.002〕，and nail cyanosis〔OR=18.312，95%CI（2.179，
153.884），P=0.007〕 were associated with MHT in IgAN. Conclusion IgAN-MHT patients had worse renal function and
more serious renal pathological damage. The common TCM syndrome in IgAN-MHT was qi-yin deficiency syndrome with blood
stasis syndrome. The clinical and pathological indices of IgAN-MHT patients had a certain level of correlation with qi-deficiency
syndrome，yin-deficiency syndrome and blood stasis syndrome. The subtypes of TCM syndromes，such as headache，blurred
vision，dry mouth with desire for drink，and nail cyanosis were the influencing factors of MHT in IgAN. Early detection，
diagnosis and treatment，concern for and improvement of symptoms related to syndromes of qi-deficiency，yin-deficiency，and
blood stasis，may contribute to decreased risk of MHT in IgAN.
【Key words】 Glomerulonephritis，IGA；Hypertension，renal；Symptom complex；Symptoms and signs；Root
cause analysis；Hypertension；Pathology，clinical

IgA 肾病（IgA nephropathy，IgAN）是最常见的原 伴 MHT 的原发性 IgAN 患者的临床、病理及中医证候
发性肾小球疾病 ［1-2］ ，也是我国终末期肾病最常见的病 特征，分析伴 MHT 的原发性 IgAN 患者中西医相关因素，
因 ［3］ 。IgAN 同时也是引起肾实质性恶性高血压（MHT） 探索其可能的中医病机。
的主要原因之一 ［4-6］ ，既往研究认为伴 MHT 的 IgAN 1 对象与方法
患者临床病情和肾脏病变程度均比无 MHT 的 IgAN 患 1.1 研究对象 纳入 2013 年 12 月至 2021 年 9 月在中
者严重 ［7］ ，其主要临床特点是肾功能不全，主要病理 国人民解放军总医院第一医学中心肾脏病科，经肾穿刺
特征是以动脉闭塞为主的微动脉病变 ［4］ ，但尚不清楚 活检确诊的原发性IgAN患者为研究对象。纳入标准：（1）
IgAN 患者发生 MHT 的危险因素。由于 IgAN 伴 MHT 的 经肾穿刺活检确诊为原发性 IgAN；（2）肾穿刺活检时
发生率并不高 ［4，8-9］ ，难以通过队列研究明确其危险因素， 年龄 18 岁及以上，性别不限；（3）有肾穿刺活检前后
因此本研究采用横断面研究，比较本院近 8 年来伴 / 不 7 d 内中医调查问卷。排除标准：（1）可评价的肾小球