IgA肾病牛津病理分型适用性及其与临床关系的研究

The clinical applicability of Oxford classification of IgA nephropathy and its relationship with clinical manifestation

目的探讨应用IgA肾病牛津分型法的临床适用性及其与临床指标的关系。方法收集191例原发性IgA肾病患者肾活检前血肌酐（SCr），24h尿蛋白定量、平均动脉压（MAP）等临床资料；依据IgA肾病牛津分型定义对肾组织切片进行病理分型；对不同牛津分型间肾活检前SCr、MAP、尿蛋白定量进行比较；对随访时SCr〉129．9μmol／L的26例患者就临床有效性进行预后多因素Logistic回归分析。结果肾组织伴有S1、T1—2型的患者比S0、T0型者。肾活检前SCr水平高（P〈0．05）。24h尿蛋白定量在M、S、E分型间无统计学差异。MAP在伴有S1、T1—2型患者中高于S0、T0型患者（P〈0．05）；多因素Logistic回归分析显示伴有T1—2是导致疗效不佳的独立危险因素。结论牛津分型实际应用仍有局限性；IgA肾病患者伴有T1-2是导致疗效不佳的独立危险因素。

Objective To investigate the clinical applicability of Oxford classification of IgA nephropathy and the relationship with clinical indicators. Methods Clinical and pathological data of 191 cases of primary IgA nephropathy, including serum creatinine（SCr）, urinary protein excretion （UP）, mean arterial pressure （MAP）,were collected. Pathological classification was done on the renal biopsy specimens by Oxford classification of IgA nephropathy. The SCr,UP and MAP before renal biopsy among the different Oxford classifications were quantitatively compared. In 26 patients with SCr〉129. 9 μmol/L during the follow-up period, the clinical effectiveness was subjected to multi-factor logistic regression analysis. Results The SCr levels in IgA nephropathy patients with S1 and T1-2 were higher than those in SO and TO. There was no significant difference in UP among other sub-types. MAP level in patients with SI or T1-2 was higher than other typess; Multi-factor logistic regression analysis showed that existence of T1-2 lesion in the Oxford classification was an independent risk factor of poor curative effectiveness. Conclusions There is limitation of clinical application of the Oxford classification. IgA nephropathy with T1 2 lesion is an independent risk factor of poor curative effectivenes of IgA nephropathy.