主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

北京中医药大学学报 ›› 2014, Vol. 37 ›› Issue (2): 135-140.doi: 10.3969/j.issn.1006-2157.2014.02.015

• 临床研究 • 上一篇    下一篇

基于因子分析与聚类分析的IgA肾病中医证候分类研究

陈明1, 万廷信2, 戴恩来1, 刘沨3, 王文革4, 刘天喜5, 李银霞2, 徐成亮2, 姜敏2, 杨百泉6   

  1. 1 甘肃中医学院 甘肃 730000;
    2 甘肃武威市人民医院;
    3 兰州大学医学部病理研究所;
    4 兰州大学第二医院;
    5 兰州大学第一医院;
    6 甘肃武威市凉州医院
  • 收稿日期:2013-08-11 出版日期:2014-02-28 发布日期:2014-02-28
  • 通讯作者: 万廷信,男,主任医师,硕士研究生合作导师,主要研究方向:中西医结合与慢性肾脏病
  • 作者简介:陈明,男,硕士
  • 基金资助:
    甘肃卫生行业科研计划项目(No.GSWST2010-12);甘肃省中医药科学技术研究课题(No.GZK-2012-54)

Classification of TCM syndromes of IgA nephropathy: factor analysis and clustering analysis

CHEN Ming1, WAN Ting-xin2, DAI En-lai1, LIU Feng3, WANG Wen-ge4, LIU Tian-xi5, LI Yin-xia2, XU Cheng-liang2, JIANG Min2, YANG Bai-quan6   

  1. 1 Gansu College of Traditional Chinese Medicine, Gansu 730000;
    2 People’s Hospital of Wuwei City, Gansu Province;
    3 Institute of Pathology, Lanzhou University Medical Center;
    4 Lanzhou University Second Hospital;
    5 Lanzhou University First Hospital; 6 Liangzhou Hospital of Wuwei City, Gansu Province
  • Received:2013-08-11 Online:2014-02-28 Published:2014-02-28

摘要: 目的 用临床流行病学的研究方法,探索原发性IgA肾病的中医证候分类方法及微观表现的证候归属,为IgA肾病宏观与微观相结合进行中医辨证寻找依据。方法 多中心采集354例IgA肾病患者的中医四诊、体格检查、实验室检查及肾脏病理资料,建立数据库,采用因子分析与聚类分析等统计学方法对其宏观及微观信息共69个因子进行中医证候非线性降维研究。结果 共提取出19个公因子,总结出IgA肾病的5个中医证候群,即脾肾阳虚兼瘀血类、脾气虚兼痰湿类、肝肾阴虚类、肺气虚兼风热类和气阴两虚兼湿热类。微观表现肾小球滤过率(eGFR)15~29 mL/min、eGFR<15 mL/min、肾小管萎缩/间质纤维化(T2)、间质炎性浸润(>50%)多见于脾肾阳虚兼瘀血类;尿蛋白≥3.5 g/d、血白蛋白降低、血胆固醇增高多见于脾气虚兼痰湿类;血压增高、尿蛋白0.2~1.0 g/d、尿蛋白1.0~3.5 g/d、eGFR 60~89 mL/min、eGFR 30~59 mL/min、肾小管萎缩/间质纤维化(T1)、纤维新月体、炎性浸润(25%~50%)、球性硬化、小动脉管壁增厚多见于肝肾阴虚类;尿潜血≥+++、系膜细胞增生(M1)、节段肾小球硬化或粘连(S1)、毛细血管内增生(E1)、细胞和细胞纤维新月体多见于气阴两虚兼湿热类。结论 因子分析与聚类分析能够帮助中医证候的分类研究,宏观与微观信息相结合进行证候分类对IgA肾病证候诊断依据的客观化和微观化具有参考价值。

关键词: IgA肾病, 中医证候, 因子分析, 聚类分析

Abstract: Objective To investigate the classification methods of TCM syndromes of primary IgA nephropathy and syndrome affiliation of micro-manifestations by using clinical and epidemiological survey, and provide some evidences for differentiation of syndromes of IgA nephropathy combining macroscopic and microscopic information. Methods The data related to information of four examinations in TCM, physical examinations, laboratory examinations and renal pathology were collected from the multicenter patients with IgA nephropathy (n=354), and a database was built. A study on nonlinear dimension reduction of TCM syndromes was conducted to analyze the macroscopic and microscopic information of 69 factors by using methods of factor analysis and clustering analysis. Results A total of 19 common factors were extracted and 5 TCM syndrome types of IgA nephropathy were summed up, including spleen-kidney yang deficiency combined with blood stagnation syndrome, spleen qi deficiency combined with phlegm dampness syndrome, liver-kidney yin deficiency, lung qi deficiency combined with wind-heat syndrome, and qi-yin deficiency combined with dampness-heat syndrome. The micro-manifestations, such as glomerular filtration rate (GFR, 15-29 mL/min), renal tubular atrophy or renal interstitial fibrosis (T2), interstitial inflammatory infiltration (>50%), were more common in spleen-kidney yang deficiency combined with blood stagnation syndrome, urine protein (≥3.5 g/d), decrease of blood albumin and increase of blood cholesterol were found mostly in spleen qi deficiency combined with phlegm dampness syndrome, higher blood pressure, urine protein (0.2 -3.5 g/d, GFR (30%-89%), renal tubular atrophy or renal interstitial fibrosis (T1), crescents fiber, inflammatory infiltration (25%-50%), ball hardening and small arterial wall thickness were common in liver-kidney yin deficiency syndrome, and urine occult blood level (≥+++), mesangial cell hyperplasia (M1), segmental glomerular sclerosis or adhesions (S1), capillary fiber hyperplasia (E1), crescent cells and crescent fiber cells were mostly seen in qi-yin deficiency combined with dampness heat syndrome. Conclusion It is helpful for classification study on TCM syndromes of IgA nephropathy by using factor analysis and clustering analysis. Meanwhile, it will provide reference of objective and microcosmic basis for diagnosis of IgA nephropathy combined with macroscopic and microscopic information.

Key words: IgA nephropathy, TCM syndrome, factor analysis, clustering analysis

中图分类号: 

  • R269.923+.1