摘要
随着医学的进步和医学模式的变化,中医体质学越来越引起人们的重视,并积极开展了许多相关性研究。在慢性肾脏病中慢性原发性肾小球疾病是发病率较高的疾病,可以导致是终末期肾病(ESRD),造成生活质量和寿命的下降,给家庭以及社会带来沉重的精神和经济担,因此早期发现、治疗原发性肾小球病至关重要。然而肾脏疾病起病隐匿,在患病初期常常“无证可循”,而中医体质学研究在疾病的预防以及早期治疗中具有很大的优势,可以应用于原发性肾脏疾病的研究与治疗中。
目的：通过随机抽样调查慢性原发性肾小球疾病患者的体质类型与其一般情况、中医证候、临床指标等资料,运用现代统计学方法,对不同体质类型原发性肾小球疾病患者临床证候与指标的相关性分析,探求不同体质类型在慢性原发性肾小球疾病中的临床特点,为中医药个体化防治慢性原发性肾小球疾病寻求客观依据,探索临床治疗的一种新思路。
方法：对符合纳入标准的患者,进行体质调查问卷,收集,患者的一般情况、中医证候、临床指标等资料,运用现代统计方法,对于上述资料进行统计学分析,探求不同体质在本病中的基本特点。并且通过对血、尿样本的TGF-β的检测,结合体质与肾脏病理,分析其之间的相关性,为中医药个体化防治原发性肾小球疾病探索新思路。
结果
1.慢性原发性肾小球疾病中以气虚质、阳虚质和平和质最为常见。同时不同体质证候分布也存在一定的差异。气虚质患者的虚性证型中肺肾气虚证最常见(47.5%),其次为脾肾阳虚。阳虚质患者中的虚性证候以脾肾阳虚证最多(40.54%),其次为肺肾气虚证。平和质患者中虚性证候以肺肾气虚证作为主体(占46.88%)。气虚(阳虚)质与非气虚(阳虚)质虚性证候的分布存在统计学意义。实性证型以湿热和湿浊最为多见,在各种体质中分布差异不明显。
2.根据尿液蛋白检测结果,气(阳)虚体质与尿蛋白定性分级呈显著正相关,且阳虚质尿蛋白水平远远高于其他体质类型。血尿素氮、白蛋白、甘油三酯水平在各体质组间差异显著,P＜0.05。血肌酐水平以阳虚质最高,平和质最低,且阳虚质与气虚质、平和质之间差异性显著(P＜0.05)。血浆白蛋白以气虚质组最高,且与其余各体质组间差异明显,具有统计学意义(P＜0.05)。其他体质组(包括阴虚质、痰湿质、湿热质、瘀血质、特禀质)甘油三酯水平最高,其次为气虚质,且阳虚质、气郁质、平和质与其他体质组差异性性显著(P＜<0.01)。总胆固醇水平以其他体质组最高,其次为气郁质,阳虚质最低且与其他体质组间差异性显著(P＜0.01)。补体C3水平各组间差异明显(P＜0.05),以阳虚质最高,平和质和气郁质最低,两两比较,平和质与气虚质、阳虚质组间差异明显(P＜<0.05),气郁质与气虚质组比较差异明显(P＜0.05)。
3.平和质中系膜增生性和膜性肾病患者最多,各占平和质例数的37.5%。气虚质中,以系膜增生性肾病为主,占42.1%。阳虚质中,局灶增生硬化性肾病最多,共占40.6%,各组间分布无明显差异。但其中阳虚质与平和质相比较,病理类型分布差异明显,P＜0.05,有统计学意义。
4. TGF-β在患者患病时尿液中含量明显高于正常人。血TGF-β1水平在各类肾脏病理类型中,以局灶增生硬化性肾病含量高1533.35±789.52pg/m1,其次为微小病变患者1512.90±774.72 pg/ml,且局灶增生硬化性肾病和微小病变肾损伤血TGF-β1水平分别与系膜增生性肾病和膜性肾脏具有显著性差异,P＜0.05。从体质学角度来看,血TGF-β1水.平在各组间差异明显,P＜0.05,具有统计学意义。其中气虚质血TGF-β1水平最高,为1503.63±757.97pg/m1,平和质和阳虚质最低,分别为947.90±642.35pg/m1和929.76±596.54pg/m1,且气虚质与平和质和阳虚质患者相比,差异有统计学意义,P＜0.05。
5.TGF-β与肾功能、血脂、血凝、血常规等指标无相关性。血TGF-β与血中IgA、IgM,尿TGF-β与血中IgA、IgG存在正向相关,尿TGF-β与补体C3存在负向相关性。经逐步回归分析,血TGF-β与IgM的回归方程为：y=713.526+344.86x,方程有统计学意义(P=0.01)；尿TGF-β与IgG的回归方程为：y=64.423+12.12x,方程有统计学意义(P＜0.01)
结论：①慢性原发性肾小球疾病中存在体质类型的差异,且不同体质的临床证候、临床资料、病理等方面均存在各自的特点,其中阳虚质患者病情较重；②本病患者生长转化因子一β1可以升高,且与肾脏病理、体质类型存在不同的相关性,且在本病初期,TGF-β1的升高除与肾脏增生纤维化相关,可能与免疫调节关系密切。③气虚质患者与本病的关联主要体现在免疫功能方面,可能与TGF-β在本病早期的免疫调节作用有关。
With advances in medicine and change of medicine model,it is interested by more and more people about the theory of constitute of TCM, and actively carried out a lot of correlated research. Chronic primary glomerular disease is a kind of prevalent kidney disease, and is the main cause of the end stage renal disease (ESRD).,which resulting in the decline of quality of life and age, bringing huge economic burden to the family and the society. So it is very important to.early discovery and treatment. However kidney disease onset conceals, it is hard to differentiate symptoms and signs in initial stage.The theory of constitute of TCM has a great advantage in the prevention of disease and early treatment of chronic kidney disease, and can be applied to research and treatment of primary kidney disease.
Objective: By observing the constitution, the people general state of health, sydrome and symptoms, clinical indicators of chronic primary glomerular disease by sampling survey with random, we try to analyze the correlation between these by mordern statistics, to explore the clinical characteristics between different type of constitution in chronic idiopathic glomerular disease for, TCM individualized prevent and treat chronic primary glomerular disease.By this way,we try to find a new way to prevent and cure chronic primary glomerular disease.
Methods:by observing the general state of health, sydrome and symptoms, clinical indicators of the people meeting the inclusion standards, filling in questionnaire of constitution,applying modern statistical methods, explore the different physical characteristics in different constitution in the disease. And through observe the level of TGF-βin the serum and urine of primary glomerular diseases, combined with the constitution and kidney pathological, analyzing the correlation between it, we try to find a new way to prevent and cure chronic primary glomerular disease.
Results:1. Deficiency Qi of constitution, Deficiency Yang of constitution, and normal constitution is more common in Chronic primary glomerular disease. At the same time different constitutions have distribution of syndrome. Deficency of lung qi and kidney qi syndrom can be seen as usually from deficency of qi constitution(47.5%).The second syndrom can be seen in this constitution is deficency of spleen yang and kidney yang syndrom.In deficency of yang constitution the most syndrome is deficency of spleen yang and kidney yang syndrom (40.54%), and secondly is deficency of lung qi and kidney qi syndrom. Yang, the virtual qualitative patients with spleen and kidney Yang syndrome (most 40.54% issuing), lung kidney deficiency syndrome.The most syndrome in constitution is deficency of lung qi and kidney qi syndrom. There were statistically significant with difference between deficiency of qi and yang constitutions and not these constitutions. The syndrome of excess were no differences,and the most frequent is syndrome of dampness and heat and syndrome of dampness.
2.According to results of proteinuria, deficiency of qi and yang constitutions with gallery level of proteinuria has conspicuous correlation. And urea nitrogen, creatinine and triglyceride in serum has conspicuous difference between various constitutions(p<0.05). In creatinine level the highest is difficiency of yang constitution, the least is normal constitution. And there are conspicuous difference between difficiency of yang constitution and deficiency of qi constitution, normal constitution (p<0.05). Deficiency of qi constitution is the highest in the level of plasma-albumin.and exist conspicuous differences with the other constitutions(p<0.05). Other constitutions group has the highest level of triglyceride and cholesterol, and exist conspicuous differences. There are different level of complement C3 between various constitutions (p<0.05).And the highest is difficiency of yang constitution,the minimun is normal constitution and stagnation of qi constitution in level of complement C3.Meanwhile, normal constitution with difficiency of yang constitution, difficiency of qi constitution has apparent difference(p<0.05), stagnation of qi constitution with difficiency of qi constitution has apparent difference(p<0.01).
3. Mesangial proliferative glomerulonephritis(37.5%) and membranous nephropathy (37.5%) is the most in normal constitution.In difficiency of qi constitution, the most is also mesangial proliferative glomerulonephritis(42.1%).And in difficiency of yang constitution, the most is sclerosing glomerulonephritis (40.6%).Compare with normal constitution and difficiency of yang,the difference is remarkable in distribution of type of pathology(p<0.05)
4.TGF-beta level in patients of chronic primary glomerular disease is 163.99±67.42,which is higher than healthy people(p<0.01).The level of TGF-beta in serum is the highest in sclerosing glomerulonephritis, the second in minimal change nephropathy. And these two types of pathology is predominance difference compared with MPG and MN(p<0.05).From aspect of constitute of TCM, The level of TGF-beta in serum is difference in various constitution(p<0.05),which has statistical significance.And difficiency of qi constitution has the highest level of TGF-beta in serum.normal constitution and difficiency of yang,the difference is the minimum.Meanwhile these distribution has significance in statistic(p<0.05).
5. The level of TGF-beta in serum relates to IgA. IgM. The level of TGF-beta in urine relates to lgA. lgG,and is negative correlation to complement C3.According to gradual regressive analysis, regression equation of the level of TGF-beta in serum and IgM is y=713.526+344.86x, the regression equation of The level of TGF-beta in urine and IgG is y=64.423+12.12x.
Conclusions:(1) There are differences in various constitutions. And different constitution has respectively characters in the aspects of syndrome, symtoms, clinical index, type of pathology,and so on. Pathogenetic condition is heavier in the difficiency of yang constitution. (2)TGF-beta level in patients of chronic primary glomerular disease can increase,and exist different correlation about type of pathology and constitution.At same time, the raising of TGF-beta may be relate to immunologic mechanism,except procedure of fibration. (3)The relationship with difficiency of qi constitution and this disease, may be reflect to aspect of immune by TGF-beta.
引文
[1]王琦.王琦医学论文集[M].北京：中国百科全书出版社,1994.
[2]王琦.中医体质分类与判定[M].北京：中国中医药出版社,2009.
[3]王琦.中医体质学[M].北京：中国医药科技出版社,1995：29.
[4]匡调元.人体体质学：中医学个性化诊疗原理[M].上海：上海科学技术出版社,2003.
[5]张洪钧,彭莉.如何从体质中寻找中医病因——兼述一个中西医结合方法[J].中国中医基础医学杂志,2003,9(2)：27-30,44.
[6]王琦.9种基本中医体质类型的分类及其诊断表述依据[J].北京中医药大学学报,2005,28(4)：1.
[7]匡调元.两纲八要辨体质新论[J].中医药学刊,2003,21(1)：108-110.
[8]匡调元.论辨证与辨体质.[J]中国中医基础医学杂志,2002,8(2)：1-5.
[9]何裕民,王莉,石凤亭,等.体质的聚类研究[J].中国中医基础医学杂志,1996,2(5)：7-9.
[10]赵进喜.《伤寒论》“六经钤百病”探识[J].中医药学刊,2005,23(2)：221-223.
[11]张洪钧.体质的分层、分类诊断初探.中国中医基础医学杂志,2008,14(4)：285-287.
[12]王琦,朱燕波,薛禾生,等.中医体质量表的初步编制[J].中国临床康复,2006,10(3)：12-14.
[13]王前奔.论体质与证的关系[J].江苏中医,1992,(6)：8.
[14]李英帅.体质与证候关系解析[J].北京中医药大学学报,2009,32(3)：156-159.
[15]高博,孙广仁.浅谈体质在异病同证形成中的基础性作用[J].实用中医杂志,2009,25(3)：188-189.
[16]彭胜权.温病学[M].上海：上海科学技术出版社,2002.
[]7]王琦.论中医体质研究的3个关键问题[J].中医杂志,2006,47(5)：329-332.
[18]武月萍.体质及体质因素与中医辨证[J].中华中医药学刊,2007,25(1 0)：2122-2123.
[19]何裕民.略论体质与年龄——附2268例对象体质与年龄的调研分析[J].中医院学报,1986,(3)：1-5.
[20]周天寒.老年人体质疾病的治疗特点初探[J].浙江中医学院学报,1990,14(1)：51.
[21]林晨,杨志敏.老年体质分类与调理策略[J].江西中医药,2008,39(5)：13-14.
[22]王莉,何裕民.男女体质特点及其异同的研究[J].中国中医基础医学杂志,1998,4(2)：79.
[23]王琦.中医体质学说研究现状与展望[J].中国中医基础医学杂志,2002,8(2)：6-14.
[24]王莉.不同年龄人群男女体质演变规律的研究[J].上海中医药大学学报,1998,12(1)：11-16.
[25]王琦,朱燕波,折笠秀树,等.中医痰湿体质相关影响因素的研究[J].北京中医药大学学报,2008,31(1)：10-13.
[26]郑承铎,郑立升,杨晓云,等.福州人饮食性味和温度高低与体质关系研究[J].中国中医基础医学杂志,2002,8(2)：58-61.
[27]王琦,龚海洋,高京宏.肥胖人痰湿体质外周血基因表达谱特征研究[J].中医杂志,2006,47(11)：851-858.
[28]倪红梅,何裕民.方盛泉青少年肾阳虚体质差异表达基因研究辽宁中医杂志[J],2007,34(9)：1220-1222.
[29]欧阳涛,宋剑南,林谦,等.冠心病体质表型和低密度脂蛋白受体基因AvaⅡ位点多态性关系的研究[J].中国中医基础医学杂志,2005,11(7),521-523.
[30]Du YP,Deng CS, Lu DY,et al. The relation between HLA-DQA1 genes and genetic susceptibility to duodenal ulcer in wuhan Hans [J]. World Gas,2000,6 (1):107-110.
[31]王琦.中医体质学[M].北京：中医医药科技出版社,1995：70-71,195-215.
[32]骆斌,黄山,王琦.肥胖人痰湿体质与人类白细胞抗原关联研究[J].北京中医学院学报,1993,16(5)：8-10.
[33]王文宝,曹峰林,李辉,等.北方汉族健康人的中医体质类型与HLA基因多态性的相关研究[J].哈尔滨医药,2002,22(2)：1-2
[34]张宇鹏,陈小野,周永生,等.10种大鼠部分指标相关性与中医体质关系的初步研究[J].现代中西医结合杂志,2003,12(4)：345-346.
[35]陈小野,周永生,樊雅莉,等.10种大鼠的中医体质学初步研究[J].实验动物科学与管理,2000,17(4)：33-39.
[36]叶福媛,宋莉君,孙爱贞.中医体质的实验研究——寒体和热体大鼠多元素多因子分析[J].广东微量元素科学,2000,7(2)：16-18.
[37]陈小野,蒋小丽,邹世洁,等.雌激素对大鼠中医体质影响的研究[J].现代中西医结合杂志,2005,14(18)：233-238.
[38]孙理军,薛昶,郝蕊,等.肾虚体质大鼠细胞因子的实验研究[J].陕西中医,2007,28(12)：1697-1698.
[39]张洪钧.基于体质调整的原发性高血压防治思路[J].中医药通报,2004,3(4)：13-14.
[40]宋红普,何裕民.476例原发性高血压患者体质特点研究[J].上海中医药大学学报,2001,15(2)：33-35.
[41]戎靖枫,周华.原发性高血压中医体质与血管重构的相关性研究[J].中西医结合心脑血管病杂志,2008,6(2)：141-143.
[42]钱岳晟,张伟忠,周怀发,等.原发性高血压患者表型与中医体质分类关系的研究[J].中国中医基础医学杂志,2002,8(2)：49-51.
[43]钱岳晟,张伟忠,周怀发,等.血压变异与高血压病患者中医体质分类的关系[J].中国中西医结合杂志,2003,23(2)：88-90.
[44]蒋宏杰,骆斌.不同体质类型脑血栓患者血液流变性、微循环观察分析[J].安徽中医临床杂志,2002,14(4)：155-156.
[45]张海梅,张云云,郭德莹,等.缺血性脑卒中患者中医体质类型与中医证型关系的研究[J].辽宁中医杂志,2009,36(7)：1067-1069.
[46]刘垣,张洪钧,田金洲,等.血管性痴呆患者体质调查[J].中华中医药杂志,2006,21(3)：148-150.
[47]苏庆民,王琦.肥胖人痰湿型体质血脂,血糖,胰岛素及红细胞Na+-K+-ATP酶活性的检测及特征[J].中国中医基础医学杂志,1995,1(2)：39-41.
[481袁婉丽,胡节惠.2型糖尿病表型与中医体质分类关系的研究[J].现代医药卫生,2004,20(24)：2602-2603.
[49]周东海,王小强,王海燕,等.2型糖尿病中医证候学与体质相关性研究[J].实用心脑肺血管病杂志,2009,17(8)：676-678.
[50]周小军,田道法.鼻咽癌家系体质调查研究[J].中国中医基础医学杂志,2002.8(11)：60-63.
[51]张洪钧.急性白血病易患体质研究及病因病机探讨[J].北京中医药大学学报,2002,25(1)：46-50.
[52]金珉廷,郑洪新.骨质疏松症的中医体质学特征[J].中华中医药学刊,2009,27(4)：824-826.
[53]赵霞.100例哮喘患儿体质调查及分型研究[J].成都中医药大学学报,2001,24(3)：16-17.
[54]童家罗.200例慢性支气管炎病理性体质类型与发病关系的分析[J].上海中医药杂志,1998(3)：14-15.
[55]夏仲元,庞洁,任卫华.乳腺增生病中医体质类型调查分析[J].安徽中医学院学报,2009,28(4)：12-14.
[56]欧之洋.中医体质学说指导老年抗衰调治管见[J].安徽中医临床杂志,2003,15(5)：422-424.
[57]王赞英.浅谈中药剂量与疗效的关系[J].福建中医药,2002,33(4)：46-47.
[58]钱彦方,王琦.轻健胶囊改善肥胖痰湿体质疗效观察[J].中医杂志,1993,34(4)：4、42-44.
[59]徐庆文,周小军,邱宝珊,等.益气养阴清热解毒法对EB病毒感染者中医体质证候的影响[J].中医药学刊,2006,24(10)：1864-1865.
[60]王力宁,李娜,张晓春.纳气敷脐散调养气虚与气阴两虚小儿体质状态的近期效果观察.中国中西医结合儿科学.2010,3：11-14.
[61]于敏,张波,王汉斌,等.从中医体质学说谈慢性肾脏病的发生与预防.中华中医药学刊,2009,27(9)：1825-1827.
[62]韦芳宁,王莉.414例慢性肾脏病患者中医体质特征研究.国际医药卫生导报,2009,15(1)：5-8.
[63]李亮、何永生.从体质论治早中期慢性肾功能衰竭的理论探讨.天津中医药,2007,24(5)：391-392.
[64]林长青,柳振宇,高彦彬.朝医辨体质治疗慢性肾功能衰竭机理探讨.陕西中医,2007,28(12)：1649-1651.
[65]李东涛.论气虚体质的特征.山东中医杂志,1998,17(9)：389-391.
[66]王琦.中医体质学[M].北京：人民卫生出版社,2005,80.
[67]崔艳,周琰,程丽娜.白细胞计数值与气虚证诊治关系初探.河北中医学报,1998,13(1)：23
[68]陈辉.中医气虚证的量化指标初探.中国中西医结合杂志,1998,18(7)：391
[69]申维玺,刘玉梅,刘晓燕.用现代医学理论阐明气虚证本质和发病学机制.医学研究通讯,2005,34(10)：6-8.
[70]申维玺,孙燕.肺癌气虚证与TGF-β1、TNF-α、PDGF关系探讨.中国中西医结合杂志,2008,28(10)：950-951.
[71]王琦,姚实林,童柑,等.阳虚体质者内分泌及免疫功能变化.中西医结合学报.2008,6(12)：1226-1231.
[72]张萍,徐凤芹.阳虚与非阳虚型慢性心力衰竭与神经内分泌相关性研究.中西医结合心脑血管病杂志,2010,8(10)：1153-1154.
[73]叶雪清,杨少文,李安.阳虚患者植物神经系统功能、甲皱微循环和血液流变学的改变及相互关系.中西医结合杂志,1989,9(10)：618-619.
[1]孙元莹,张玉梅,姜德友.张琪教授治疗慢性肾小球肾炎经验[J].四川中医,2006,24(2)：1.
[2]金劲松.邵朝弟治疗慢性肾炎的经验[J].湖北中医杂,2007,29(5)：16-17.
[3]刘玉宁,郭立中,王立红,等.叶传蕙教授对慢性肾小球肾炎的中医治疗[J].中国中西医结合肾病杂志,2001,2(10)：562-565.
[4]李靖.吕仁和教授对-肾络瘕说-的认识及分期辨治隐匿性肾小球肾炎[J].中国中西医结合肾病杂志,2009,10(8)：661-663.
[5]郑建功.赵绍琴辨治慢性肾炎心法[J].浙江中医杂志,2008,43(4)：187-189.
[6]郑春燕,琚玮,黄生生.郑建民教授治疗IgA肾病经验[J].中医研究,2006,19(2)：44-45.
[7]余仁欢.聂莉芳教授治疗IgA肾病的经验[J].中国中西医结合肾病杂,2007,8(1)：4-5.
[8]李国霞,黄文政.系膜增生性肾炎肾小管间质损害的中医病因病机探讨[J].江苏中医药,2008,40(4)：16-17.
[9]赵代鑫,杨霓芝.杨霓芝教授治疗系膜增生性肾小球肾炎的临证经验[J].中国中西医结合肾病杂志,2009,10(4)：288-289.
[10]肖敬辉.中医辨证治疗慢性肾小球肾炎60例临床观察[J].中国中西医结合肾病杂志,2002,3(12)：35-36.
[11]耿丽芬,陈志强,杨洪涛,等.辨证治疗慢性肾小球肾炎53例临床观察[J].河北中医,2004,26(1)：22-23.
[12]中华中医药学会肾病分会.慢性肾小球肾炎的诊断、辨证分型及疗效评定[J].上海中医药杂志,2006,40(6)：8-9.
[13]刘玉宁,郭立中,王立红,等.叶传蕙教授对慢性肾小球肾炎的中医治疗[J].中国中西医结合肾病杂志,2001,2(10)：562-565.
[14]许筠.刘宝厚教授论治肾病临证经验摘萃[J].中国中西医结合肾病杂志,2008,9(4)：285-287.
[15]许慎吾.中西医结合治疗慢性肾炎28例[J].实用中医药杂志,2004,20(6)：311.
[16]张锦玺,王俊苗.杜雨茂教授治疗肾病经验述略[J].国医论坛,1999,14(2)：20-21,8
[17]韩履祺.于家菊教授治疗慢性肾炎临床经验[J].中国中西医结合肾病杂志,2005,6(7)：377-378
[18]卢巧珍.陈以平治疗IgA肾病的经验[J].中医文献杂志,2004(2)：40-42.
[19]高志卿,邓跃毅,王琳.陈以平教授分期论治膜性肾病[J].上海中医药杂志,2004,38(2)：35-36.
[20]邓祥雄,黄俊山.慢性肾炎辨治体会[J].福建中医,1997,28(2)：32-33.
[21]聂莉芳.IgA肾病的中医辨证论治研究[J].中医杂志,2003,44(8)：70-71.
[22]曾慧莲.中西医结合分期治疗慢性肾小球肾炎体会[J].现代中西医结合杂志,2004,13(12)：1611.
[23]李平.时振声教授治疗慢性肾炎临床经验[J].中国中西医结合肾病杂志,200,6(3)：7-9.
[24]王晓静,李炳文.李炳文教授治疗慢性肾小球肾炎经验[J].陕西中医学院学报,2004,27(1)：41.
[25]陈香美,陈建,陈以平,等.肾华片治Ig肾病(气阴两虚证)多中心随机对照临床观察[J].中国中西医结合杂志,2007,27(2)：101-105.
[26]米秀华,吴艺青,李珺,等.实脾固肾化瘀方治疗慢性肾炎疗效观察[J],上海中医药杂志,2010,7：49-50.
[27]魏晓娜,檀金川,杨凤文祛风胜湿方治疗IgA肾病患者40例[J].中医杂志,2010,51(6)：35.
[28]郭聂涛,杨进,李燕林.益气养阴方治疗慢性肾小球肾炎临床观察[J].中华中医药学刊.2009,27(8)：1743-1744.
[29]傅贵平,邓跃毅,崔莉.陈以平治肾八法及用药经验拾萃[J].辽宁中医杂志,2007,34(8)：1039-1040.
[30]杨永超,任小宁,李飞燕,等.叶传蕙教授从湿热论治肾性蛋白尿经验[J].中国中医急症.2007,16(6)：63、101.
[31]赵代鑫,杨霓芝.杨霓芝教授治疗系膜增生性肾小球肾炎的临证经验[J].中国中西医结合肾病杂志,2009,10(4)：288-289.
[32]邓聪.从风郁瘀论治蛋白尿[J].中华中医药杂志,2006,21(8)：506.
[33]史佳影,董志刚.董志刚教授治疗肾炎血尿的经验[J].中华中医药学刊,2008,26(6)：20-21.
[34]姚瑶,石君华.邵朝弟从五脏论治血尿的经验[J].湖北中医杂,2010,32(3)：32-33.
[35]王燕涛,李蕾,赵良斌.叶传蕙教授治疗肾性水肿的经验[J].云南中医中药杂志,2010,31(1)：6-7.
[36]王永钧.肾性水肿证治八法[J].浙江中医学院学报,2004,28(2)：4-7.
[37]林启展,董金莉,潘碧琦.张琪教授治疗肾性水肿的经验[J].四川中医,2006,24(7)： 1-2.
[38]陈荣源,孙红颖,韩东彦.聂莉芳运用调理脾胃法治疗难治性肾病综合征水肿的经验[J].上海中医药杂志,2007,41(5)：54-55.
[39]黄黎明,石晓强,梁恒.黄芪、山茱萸对肾炎小鼠尿蛋白谱的影响[J].中国中药杂志,2007,32(13)：1324-1327.
[40]任现志,翟文生.黄芪、水蛭及其不同比例配方含药血清对大鼠GMCs增殖及分泌TGF-β1的影响[J].中国中医基础医学杂志,2007,13(5)：358-359.
[41]倪兆慧,张庆怡.黄芪对人肾小球系膜细胞CD44mRNA表达的影响[J].中国中西医结合肾病杂志,2001,2(1)：13-16.
[42]沈健,许惠琴.黄芪注射液对AGEs培养肾小球系膜细胞的影响[J].中成药,2006,28(8)：1170-1174.
[43]张雯,程军,陶筱娟,等.雷公藤多甙对IgA肾病小鼠肾皮质PDGF-B及受体表达的影响[J].中国中医药科技,2008,15(5)：33-34.
[44]毛炜,郭立中,庞嶷,等.雷公藤药物血清体外对肾小球系膜细胞增殖及其分泌IL-6的影响[J].第四军医大学学报,2006,27(13)：1204.
[45]赵丽.雷公藤多甙与环磷酰胺治疗难治性肾病综合征的对照观察[J].河北医药,2009,31(16)：2160-2161.
[46]钟丹,刘明平,邹亦平,等.三七总皂甙对系膜增生性肾小球肾炎模型大鼠血液流变学的影响[J].中国老年学杂志,2010,30(4)：958-959.
[47]祝正明,孙建实,赵湘.三七总皂苷对大鼠肾小球系膜细胞CTGF表达及细胞外基质产生的影响[J].中华中医药学刊,27(4)：853-855.
[48]郑宏,翟文生,任现志,等.黄芪、水蛭含药血清对大鼠肾小球系膜细胞产生TGF-β1的影响[J].天津医药,2007年,35(7)：509-511.
[49]顾江萍,梁鑫淼.水蛭对大鼠肾小球系膜细胞增殖的影响[J].中药材,2008,31(6)：894-895.
[1]李甘地.病理学[M].北京：人民卫生出版社,2001：310-327.
[2]俞雨生,王金泉.IgA肾病临床及其发病机制的新观点[J].肾脏病与透析肾移植杂志,2006,15(1)：60-61.
[3]Darvill AM, Ballardie FW. Mesangial autoantigens in IgA nephropathy:matrix synthesis and localization[J]. J Lab Clin MED,2006,147(6):301-309.
[4]Kalluri R,Sun MJ, Hudson BG et al.The goodpasture autoantigen: structural elineation of two immunogically privileged epitopes on alpha3(IV) chain of type IV collagen[J].J Biochem,1996,271 (15):9062-9068
[5]Couser WG, Steinmuller DR,Stilmant NM, et al. Experimental glomerulonephritis in the isolated perfused rat kidney[J].J Clin Invest,1978,62 (6):1275-1287.
[6]CouserWG, Salant DJ. In situ immune complex formation and glomerular injury [J]. Kidney Int,1980,17 (1):1-13.
[7]Roos A, Rastaldi MP, Calvaresi N, et al. Glomerular activation of the lectin pathway of complement in IrA nephropathy is associated with more severe renal disease[J]. J Am Soc Nephrol,2006,17(6):1724-1734.
[8]张瑶,曹灵.膜性肾病的发病机制新进展.山东医药.2009,49(52)：106-107.
[9]王海燕主编.肾脏病学[M].第3版.北京：人民卫生出版社,2008.
[10]Fiser RT, Arnold WC, Charlton RK,et al. T-lymphocyte subsets in nephrotic syndrome[J]. Kidney Int,1991,40(5):913-916. [11]Shao XS, Yang XQ, Zhao XD, et al. The prevalence of Th17 cells and FOXP3 regulate T cells(Treg) in children with primarynephritic syndrome[J]. Pediatr Nephrol, 2009,24(9):1683-1690.
[12]陈蓉.慢性肾炎患者免疫病理机制的探讨.内蒙古中医药,2008,3：11-12.
[13]Cattran DC, Greenwood C,Ritchi S et al. A controlled trial of cyclosporine in patients with progressive membranous nephropathy:Canadian glomerulonephritis study group [J]. Kidney Int,1995,47:1130.
[14]Clark DA, Coker R. Transforming growth factor-beta (TGF-beta) [J]. Int J Biochem Cell Biol,1998,30(3):293-308.
[15]Kretzschmar M,M assague J. Current Opinion in Genetics and Development [J]. Kidney Int,1998,8 (2):103-110.
[16]Chen H B,Rud J G, Lin K, et al. Nuclear targeting of transforming growth factor-beta-activated Smad complexes[J]. Biochem,2005,280 (22):21329-21336.
[17]Massague J,Blain SW, Lo RS. TGF-beta signaling in growth control, cancer, and heritable disorders [J]. Cell,2000,103 (2):295-309.
[18]el Nahas AM, Muchaneta-Kubara EC,Essawy M, et al.Renal fibrosis:insights in to pathogensis and treatment[J]. Int J Biochem Cell Bid,1997,29(1):55-62.
[19]Thorbecke GJ,Umetsu DT, DeKruyff RH, et al. When engineered to produce latent TGF-betal, antigen specific T cells down regulate Thl cell-mediated autoimmune and Th2 cell-mediated allergic inflammatory processes [J]. Cytokine Growth Factor Rev,2000,11 (1-2):89-96.
[20]Mittal RD,Manchanda PK.Is low-frequency distribution of TGF-beta genotype associated with increased risk for end-stage renal disease[J]?DNA Cell Biol,2007,26(3):172-177.
[21]Huang XR, Chung AC, Zhou L, et.al. Latent TGF-betal protects against crescentic glomerulonephritis[J]. Jam Soc Nephrol,2008,19(2):233-242.
[22]Cordeiro MF. Beyond mitomycin:TGF-beta and wound heal ing [J]. Prog Retin Eye Res,2002,21(1):75.
[23]El Nahas AM, Machaneta-kubara EC, Essawy M,et al. Renal fibrosis:insights in to pathogensis and treatment [J]. Int J Biochem Cell Bid,1997,29 (1):55-62.
[24]孙铭柱,徐曼,邹万忠.肾小管间质纤维化中成纤维细胞的转化生长因子-B1及其I型受体蛋白及基因表达检测[J].临床与实验病理学杂志,2000,16(1)：134-136.
[25]M alyankar UM, Almeida M, Johnson RJ, et al. Osteopontin regulation in cultured rat renal epithelial cells [J]. Kidney Int,1997,51 (5):176621773.
[26]Hocher B, Thone2Reineke C, Rohmeiss P, et al. Endothelintrasgenicm ice develop glomenrulosclerrosis, interstitial fibrosis, and renel cysts but not hyperension [J]. J Clin Invest,1997,99 (4):1380-1389.)
[27]Brian E. Aspects of free radical reactions in biological system: anaging[J]. J Gerontol,1980,35 (1):4512.
[28]唐政,季大,黎磊石,等.丙丁酚治疗慢性肾功能衰竭大鼠对残余肾单位抗氧化酶的影响[J].肾脏病与透析肾移植杂志,1995,4(1)：9213.
[29]Mocan H, Aksoy A, Uydu HA, et al. Pediatr Nephrol,1999 May;13 (4):326.
[30]Border WA, Okuda S,Languino LR,et al. Rapidly progressive glomerulonephritis [J].Kidney Int,1990,37:68.
[31]Hricik DE, Chung-park M, Sedor J R. Glomerulonephritis [J]. N Engl J Med,1998,339:888.
[32]石鹏.活血化瘀法与肾病综合征[J].陕西中医函授,1997,3(1)：19-20.
[33]杜义斌,沈世忠.叶任高教授中西结合治疗膜性肾病型肾病综合征的临床经验[J].中国中西医结合肾病杂志,2001,2(1)：425
[34]郑智勇,刘秉翰,余英豪,等.IgA肾病肾小球毛细血管内血浆蛋白淤积的临床病理意义[J].中国微循环,2000,4(1)：47-49.
[35]Hsu SI, Winn MP, Oemmer JS, et al. Evidence for genetic factors in the development and progression of IgA nephropathy[J]. J Kidney Int,2000,57(5): 1818-1835.
[36]Gharavi AG, Yan Y, Scolari F, et al. IgA nephropathy, the most common cause of glomerulonephritis, is linked to 6q22-23[J]. NatGenet,2000,26(3):354-357.
[37]Gloy J, Henger A, Fischer KG, et al. Angiotensin Ⅱ modulates cellular functions of podocytes[J]. Kidney Int Suppl,1998,67:S168-170.
[38]01iveira DB. The immune pathogenesis of membranous nephropathy[J]. Minerva Med,2002,93 (5):323-328.
[1]Xue JL,MaJ Z, Louis TA, et al. Forecast of the number of patients with end-stage renal disease in the United states to the year 2010[J]. Am Soc Nephrol,2001,12 (12):2753-2758.
[2]张路霞,左力,徐国宾,等.北京市石景山地区中老年人群中慢性肾脏病的流行病学研究[J].中华肾脏病杂志,2006,22(2)：67-71
[3]王海燕.原发性肾小球疾病分型与治疗及诊断标准专题座谈会议纪要[J].中华内科杂志,1993,32(2)：131-132.
[4]王琦.中医体质分类与判定[M].北京：中国中医药出版社,2009.
[5]王琦.中医体质学[M].北京：中国医药科技出版社,1995：29.
[6]王耀献,刘尚建,付天昊,等.肾络微型癥瘕探微[J].中医杂志,2006,47(4)：247-249.
[7]王琦.9种基本中医体质类型的分类及其诊断表述依据[J].北京中医药大学学报,2005,28(4)：1-8.
[8]苏庆民,王琦.肥胖人痰湿型体质血脂、血糖、胰岛素及红细胞Na+一K+-ATP酶活性的检测及特征[J].中国中医基础医学杂志,1995,1(2)：39-41.
[9]钱岳晟,张伟忠,周怀发,等.原发性高血压患者表型与中医体质分类关系的研究[J].中国中医基础医学杂志,2002,8(2)：49-51.
[10]El N ahas AM, M achaneta2kubara EC, Essawy M, et al. Renal f ibro sis:insigh ts in to pathogensis and treatment[J]. Int J Biochem Cell Bid,1997,29 (1): 55-62.
[11]Malyankar UM, Almeida M, Johnson RJ, et al.0 steopontin regulation in cultured rat renal epithelial cells [J]. Kidney Int,1997,51 (5):1766-1773.
[12]Hocher B, Thone2Reineke C, Rohmeiss P, et al. Endothelin-trasgenicm ice develop glomenrulosclerrosis, interstitial fibrosis, and renel cysts but not hyperension [J]. J Clin Invest,1997,99 (4):1380-1389.
[13]Cheng SF, David HL. Gelatinase A(MMP-2) is necessary and sufficient for renal tubular cell epithelial-mesenchymal transformation[J]. Am J Pathol,2003,162 (12):1937-1949.
[14]Koyama A, Fujisaki M, Kobayashi M, et al. A glomerula permeability factor produced by human T-cell hybridomas. Kidney Int,1991,40(3):453-460.
[15]Daniel V, Trautmann Y, Konyad M, et al. Tlymphocyte population, cytokines and other growth factors in serum and urine of children with idiopathic nephrot-ic syndrome[J]. Clin Nephrol,1997,47:289-297.
[16]Yoshizawa N, Kusumi Y, Matsumoto K et al. Studies of a glomerular permeability factor in patients with minimal change nephrotic syndrome. Nephron,1989,51(3): 370.
[17]Thorbecke GJ,Umetsu DT, DeKruyff RH,et al. [J]. Cytokine Growth Factor Rev,2000,11(122):89-96.
[18]Huang XR,Chung AC,Zhou L,et,al.Latent TGF- betal protects against crescentic glomerulo nephritis.J Am Soc Nephrol,2008,19(2):233-242.
[19]孙章松,沈汉超.升高的血清TGF-β1反映在慢性肾炎中的免疫抑制[j].中国中西医结合肾病杂志,2008,9(9)：808-801.
[20]申维玺,刘玉梅,刘晓燕.用现代医学理论阐明气虚证本质和发病学机制[J].医学研究通讯,2005,34(10)：6-8.
[21]申维玺,孙燕.肺癌气虚证与TGF-β1、TNF-α、PDGF关系探讨中国中西医结合杂志[J].2008,28(10)：950-951.
[20]Thorbecke GJ,Umetsu DT,DeKruyff RH,et al.When engineered to produce latent TGF-betal,antigen specific T cells down regulate Thl cell-mediated autoimmune and Th2 cell-mediated allergic inflammatory processes[J].Cytokine Growth Factor Rev,2000,11(1-2):89-96.