【目的】 分析特发性膜性肾病（IMN）患者舌象图像特征与疾病风险程度的相关性。【方法】 基于IMN临床研究电子数据采 集系统，采用横断面研究方法，分析来源于广东省中医院的135例IMN患者的临床诊疗数据，按疾病风险程度分组，分析舌 象图像特征（以TB表示舌质，TC表示舌苔，L表示亮度，a表示红色-绿色轴，G表示绿色值，B表示蓝色值，AUT表示自相 关值）与疾病风险程度的相关性。【结果】 比较IMN不同风险程度患者的舌象图像特征指标，结果发现：（1）IMN患者的疾病风 险程度越高，TB-L、TB-G、TB-B的数值越大（P < 0.05或P < 0.01）；不同风险程度的IMN患者舌象图像指标中TB-a和TC-a 的数值均表现为低风险组 > 高风险组 > 中风险组 > 很高风险组（P < 0.05）。（2）线性回归分析结果显示，与中、低风险组比 较，高风险组的 TB-L、TB-G、TB-B 显著升高（P < 0.05或 P < 0.01），而中、低风险组之间无显著性差异（P > 0.05）。（3）相 关性分析结果显示，大部分的舌象图像特征指标（包括 TB-L、TB-G、TB-B、TB-AUT、TC-L、TC-G和 TC-B等）与疾病风 险程度之间存在正相关关系，而TB-a与疾病风险程度呈负相关，差异均有统计学意义（P < 0.05或P < 0.01）。（4）所有患者均 使用中药和/或中成药，且46.7%患者使用激素及免疫抑制剂，各组间使用激素及免疫抑制剂比较，差异无统计学意义（P＝ 0.637）。【结论】 IMN患者舌象图像特征与疾病风险程度存在相关性，该结果可为IMN患者的病情评估及中医辨证提供客观化 的参考依据，通过舌象特征变化，精准感知病情变化，比传统的“视”诊更加准确。

Objective To analyze the correlation between tongue image features and the risk levels of disease in patients with idiopathic membranous nephropathy（IMN）. Methods Based on IMN clinical research electronic data acquisition system，a cross-sectional study method was used to analyze the clinical diagnosis and treatment data of 135 IMN patients from Guangdong Provincial Hospital of Chinese Medicine. The patients were grouped according to the risk levels of disease，and then the correlation between the risk levels of disease and tongue image features was analyzed. During the description of tongue image features，TB is for tongue body，TC is for tongue coating，L is for luminance，a is for red-green axis，G is for the value of green，B is for the value of blue，and AUT is for the value of autocorrelation. Results The comparison of tongue image feature indicators of patients with different risk levels of IMN showed that：（1）the higher the level of disease risk of IMN patients，the greater the values of TBL，TB-G and TB-B（P < 0.05 or P < 0.01）. The values of tongue image indicator TB-a and TC-a of the patients with different risk levels of IMN were shown in decreasing sequence：low-risk group > high-risk group > middlerisk group > extremely-high-risk group（P < 0.05）.（2）Linear regression analysis showed that TB-L，TB-G， and TB-B were significantly increased in the high-risk group compared with those in the middle - and low-risk groups（P < 0.05 or P < 0.01），whereas there were no significant differences between the middle-risk group and low-risk group（P > 0.05）.（3）The results of correlation analysis showed that there was a positive correlation among most of the tongue image feature indicators（including TB-L，TB-G，TB-B，TB-AUT，TC-L，TC-G， and TC-B，etc.）and the risk level of disease，while TB-a was negatively correlated with the risk level of disease， and the differences were all statistically significant（P < 0.05 or P < 0.01）.（4）All patients were treated with Chinese medicine and / or Chinese patent medicine， and 46.7% of patients were given hormones and immunosuppressants， and there was no statistically significant difference in the the use of hormones and immunosuppressants among various groups（P = 0.637）. Conclusion There is a correlation between the tongue image features of IMN patients and the risk level of disease，and the results will provide an objective reference for the assessment of illness state and traditional Chinese medicine（TCM）syndrome differentiation of IMN patients. With reference to the changes in the tongue image features，the illness state can be precisely identified，which is more accurate than the inspection of four diagnostic methods of TCM.

R277.5；R692.6

省部共建中医湿证国家重点实验室专项（编号：SZ2021ZZ36，SZ2021ZZ09，SZ2021ZZ02）；广州市科技计划项目（编号：2023A03J0746， 2024A03J0117）；广东省自然科学基金项目（编号：2022A1515011628）；广东省中医药局科研项目（编号：20225026）；广东省中医院中医药 科学技术研究专项（编号：YN2023MB02，YN2023MB10）