ANCA相关性血管炎肺、肾受累患者的中医临床特征及病因病机探析OA

Objective To analyze the traditional Chinese medicine(TCM)syndrome characteristics of patients with lung and/or kidney involvement in antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV).Methods A retrospective analysis was conducted on 134 patients diagnosed with AAV involving the lungs and/or kidneys at Beijing Hospital of Traditional Chinese Medicine from January 2012 to February 2024.Their TCM four-diagnostic information and syndrome differentiation data were analyzed retrospectively.Results Among the 134 patients,38 cases were identified during routine physical examinations.The remaining patients presented with 18 types of initial symptoms,among which fever and cough were the most common,followed by sputum production,wheezing,fatigue,and muscle pain.A total of 28 symptoms were recorded in the 134 patients.The major chief complaints included cough,fatigue,sputum production,wheezing,and abnormal urination.Significant differences were observed among the lung involvement,kidney involvement,and lung-kidney involvement groups in the proportions of cough,fatigue,sputum production,wheezing,nocturia,foamy urine,edema,soreness and weakness of the lower back and knees,nausea and vomiting,palpitations,and dizziness(P<0.05).Compared with patients in the stable stage,patients in the active stage had higher proportions of fatigue,nocturia,fever,myalgia,weight loss,hearing impairment or deafness,and bleeding(P<0.05).Among the 134 patients,118 cases were classified as mixed deficiency-excess syndromes,11 as excess syndromes,and 5 as deficiency syndromes.Deficiency syndromes were mainly characterized by qi deficiency.According to Zangfu syndrome differentiation,kidney qi deficiency was the most common syndrome type,followed by lung qi deficiency and spleen qi deficiency.Excess syndromes were mainly characterized by internal retention of dampness-turbidity,obstruction of the exterior by damp pathogens,and phlegm-dampness accumulation in the lungs.Significant differences were observed among the three groups in the proportions of kidney qi deficiency,lung qi deficiency,kidney yang deficiency,lung yang deficiency,internal retention of dampness-turbidity,internal accumulation of dampness-heat,phlegm-dampness accumulation in the lungs,internal retention of water-dampness,and water-fluid encumbering the heart(P<0.05).Compared with the stable stage,patients in the active stage had significantly higher proportions of internal accumulation of dampness-heat,obstruction of the exterior by damp pathogens,and heat entering the nutrient-blood system(P<0.05).The disease locations in the 134 patients were mainly distributed in the kidneys and lungs,followed by the spleen and the defensive exterior.Significant differences were observed among the lung involvement,kidney involvement,and lung-kidney involvement groups in disease locations involving the kidney,lung,spleen,defensive exterior,and heart(P<0.05).Compared with the stable stage,patients in the active stage showed higher proportions of disease locations involving the kidney,spleen,defensive exterior,and nutrient-blood level(P<0.05).Conclusion The clinical manifestations of AAV are complex and diverse,with mixed deficiency-excess syndromes.Syndrome characteristics differ according to the affected organs and disease stages.Patients with lung involvement mainly exhibit interior manifestations of the Taiyin lung system,whereas patients with kidney involvement more commonly present syndromes related to Taiyin spleen earth and Shaoyin heart-kidney systems.Compared with the stable stage,the active stage is more often characterized by the coexistence of internal and external pathogenic factors,more exterior syndromes,and a greater tendency to involve the nutrient-blood level.Deficiency of healthy qi is the internal basis for the occurrence of this disease.Dampness and cold pathogens are common external causes,while dampness,phlegm,retained water,fluid retention,and blood stasis are the pathological products of the disease.The disease is mainly located in the exterior and interior of the Taiyin and Shaoyin systems.