伴血尿IgA肾病儿童临床、病理及中医证型分析OA

Objective To investigate the relationship between hematuria and the clinical manifestations,renal pathological characteristics,and Traditional Chinese Medicine(TCM)syndrome patterns in children with IgA nephropathy accompanied by hematuria.Methods A total of 64 children diagnosed with primary IgA nephropathy via renal biopsy at the Department of Nephrology and Purpura,Pediatric Hospital of The First Af-filiated Hospital of Henan University of Chinese Medicine from September 2019 to January 2024 were selected.Based on the presence of gross hematuria,they were divided into a gross hematuria group(42 cases)and a non-gross hematuria group(22 cases).Differences in clinical indicators,renal pathology,and TCM syndromes were compared between the two groups to summarize the relationship between IgA nephropathy and hematuria.Results 1)Clinical indicators.① General indicators:Children in the gross hematuria group had a younger age of onset and were more likely to have a preceding infection before disease onset;the differences between the two groups were statistically significant(P＜0.05).No statistically significant differences were found be-tween the two groups regarding gender or hypertension(P＞0.05).② Laboratory indicators:Compared with the non-gross hematuria group,children in the gross hematuria group had lower serum uric acid levels and high-erred blood cells levels,and the difference between the two groups was statistically significant(P＜0.05).No statistically significant differences were found between the two groups in blood urea nitrogen,serum creati-nine,hemoglobin,serum IgA,or 24-hour urinary protein quantification(P＞0.05).2)Renal pathology.① Im-munofluorescence:There were no statistically significant differences in the deposition cases of IgG,IgM,C3,C1q,and FRA between the two groups(P＞0.05).(2)Oxford pathological classification:no statistically signifi-cant differences were found between the two groups in mesangial hypercellularity(M1),endocapillary hyper-cellularity(E1),segmental glomerulosclerosis/adhesion(S1),tubular atrophy/interstitial fibrosis(T1,T2),or cellular/fibrocellular crescent formation(C1,C2)(P＞0.05).③ TCM syndromes:Compared with the non-gross hematuria group,the gross hematuria group had a higher number of cases with damp-heat in the lower Jiao syn-drome and fewer cases with spleen-kidney yang deficiency syndrome;the differences between the two groups were statistically significant(P＜0.05).No statistically significant differences were found between the two groups regarding patterns such as external wind-heat,lung-spleen qi deficiency,qi-yin deficiency,and liver-kidney yin deficiency(P＞0.05).Conclusion Children with IgA nephropathy presenting with gross hematuria tend to have a younger age of onset and are often associated with preceding infections.Their TCM syndromes are predominantly excess patterns,and uric acid levels are lower compared to those without gross hematuria,whose patterns are mainly deficiency patterns.However,there were no significant differences between the two groups concerning major factors affecting the prognosis of IgA nephropathy,such as hypertension,blood urea nitrogen,serum creatinine,24-hour urinary protein quantification,renal pathological types,and related im-mune complexes.This suggests no significant difference in prognosis between the two groups.