【目的】 基于真实世界研究探讨慢性持续期IgA肾病（IgAN）中医证候分布特征及不同中医证型与预后的关系。【方法】 纳 入2018年1月至2024年1月于首都医科大学附属北京中医医院就诊的慢性持续期IgAN患者80例，收集其临床基线资料和相 关预后信息，主要结局指标定义为肾衰竭事件[肾小球滤过率（eGFR）下降＞50%，血肌酐翻倍或终末期肾病（ESRD）]，探讨 慢性持续期IgAN的中医证候分布特征及不同本虚证与预后的关系。【结果】（1）80例慢性持续期IgAN患者中，出现频率大于 30%的证候由高到低依次为泡沫尿（75.00%）、神疲乏力（71.25%）、腰酸（61.25%）、口干（31.25%）、下肢水肿（31.25%）、畏 寒肢冷（30.00%）、失眠（30.00%）等。（2）中医证型分布方面，慢性持续期 IgAN 患者本虚证以气阴两虚证最多见，共 28 例 （35.00%）；其他依次为脾肾阳虚证 22例（27.50%），肺脾气虚证和肝肾阴虚证各 15例（18.75%）。兼证以水湿证最多见，共 17 例（21.25%）；其他依次为湿热证 15例（18.75%），血瘀证 9例（11.25%），痰湿证 7例（8.75%），浊毒证 5例（6.25%），肝郁 证3例（3.75%），寒湿证1例（1.25%）。（3）80例慢性持续期IgAN患者中，共21例（26.25%）发生肾衰竭事件，其中肺脾气虚证 9例（60.00%），脾肾阳虚证 6例（27.27%），肝肾阴虚证 3例（20.00%），气阴两虚证 3例（10.71%）；经 χ2检验，肺脾气虚证的 肾衰竭事件发生率显著高于其他3组，差异有统计学意义（P＜0.05）。（4）Kaplan-Meier 生存分析结果显示，肺脾气虚证患者 2年及5年终点事件的累积发生率分别为23.10%、46.20%，最终发生率为85.00%；其他本虚证患者2年及5年终点事件的累 积发生率分别为 4.50%、19.70%，最终发生率为 71.60%；经 Log-rank组间比较，肺脾气虚证患者的肾衰竭事件发生率显著 高于其他本虚证患者，差异有统计学意义（P＜0.05）。（5） COX 比例风险回归分析显示，肺脾气虚证（HR=7.755，95%CI 1.631 ~ 36.874，P＜0.05）和贫血（HR=8.205，95%CI 1.007 ~ 66.857，P＜0.05）是慢性持续期IgAN患者肾衰竭事件发生的独立 危险因素。【结论】 慢性持续期IgAN以气阴两虚证最多见；肺脾气虚证和贫血是IgAN发生肾衰竭事件的独立危险因素。

Objective To investigate the distribution of traditional Chinese medicine （TCM） syndromes in chronic persistent immunoglobulin A nephropathy （IgAN） and to explore the relationship between TCM syndromes and prognosis based on real-world research. Methods From January 2018 to January 2024，a total of 80 patients with chronic persistent IgAN who were admitted to Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University were included. The clinical baseline data and prognosis-related information were collected. The main outcome indicators were defined as renal failure events of glomerular filtration rate （eGFR） decreased by＞ 50%，serum creatinine doubled or end-stage renal disease（ESRD）. The distribution of TCM syndromes in chronic persistent IgAN and the relationship between different deficiency syndromes and prognosis were preliminarily discussed. Results （1） Among the 80 patients with chronic persistent IgAN，the syndrome manifestations with an occurrence frequency of more than 30% in descending order were foamy urine（75.00%），fatigue and lassitude （71.25%），waist ache （61.25%），dry mouth （31.25%），lower extremity edema（31.25%），aversion to cold and cold limbs（30.00%），and insomnia （30.00%）.（2） The commonly-seen root-deficiency syndrome in patients with chronic persistent IgAN was qi and yin deficiency syndrome，with a total of 28 cases （35.00%）. And other rootdeficiency syndromes were spleen and kidney yang deficiency syndrome in 22 cases （27.50%），lung and spleen qi deficiency syndrome in 15 cases （18.75%），and liver and kidney yin deficiency syndrome in 15 cases （18.75%）. The commonly-seen complicated syndrome was water-damp syndrome，with a total of 17 cases （21.25%）. The other complicated syndromes were damp-heat syndrome in 15 cases （18.75%），blood-stasis syndrome in 9 cases （11.25%），phlegm-damp syndrome in 7 cases （8.75%），turbidity-toxin syndrome in 5 cases （6.25%），liver depression syndrome in 3 cases （3.75%），and cold-damp syndrome in 1 case （1.25%）.（3）Among the 80 patients with chronic persistent IgAN，21 cases （26.25%） had renal failure events，and their syndrome types were lung and spleen qi deficiency syndrome in 9 cases （60.00%），qi and yin deficiency syndrome in 3 cases （10.71%）， liver and kidney yin deficiency syndrome in 3 cases （20.00%），and spleen and kidney yang deficiency syndrome in 6 cases （27.27%）. The incidence of renal failure events in patients with lung and spleen qi deficiency syndrome was significantly higher than that in the other three syndrome types， and the chi-square test showed that the difference was statistically significant （P＜0.05）.（4） Kaplan-Meier survival analysis showed that the cumulative incidence of 2-year and 5-year endpoint events in patients with lung and spleen qi deficiency syndrome was 23.10% and 46.20%，respectively，and the final incidence was 85.00%. The cumulative incidence of 2-year and 5-year endpoint events in patients with other deficiency syndromes was 4.50% and 19.70%，respectively，and the final incidence was 71.60%. The intergroup comparison （tested by Log-rank） showed that the incidence of renal failure events in patients with lung and spleen qi deficiency syndrome was significantly higher than that in patients with other root-deficiency syndromes， and the difference was statistically significant （P＜0.05）. （5）COX proportional hazard regression analysis showed that lung and spleen qi deficiency syndrome （HR = 7.755，95%CI 1.631-36.874，P＜0.05） and anemia （HR = 8.205，95%CI 1.007-66.857，P＜0.05） were the independent risk factors for renal failure events in patients with chronic persistent IgAN. Conclusion Qi and yin deficiency syndrome is the most common syndrome in the patients with chronic persistent IgAN， and lung and spleen qi deficiency syndrome and anemia are the independent risk factors for renal failure events in IgAN.

R277.52

北京市属医院科研重点培育计划项目（编号：PZ2024013）