IgA肾病牛津分型在肾脏预后评价中的应用

Application of the Oxford Classification of IgA Nephropathy to Predict Renal Outcome

目的探讨IgA肾病牛津分型用于评价临床谱更广的、中国患者肾脏预后的有效性。方法回顾性分析533例IgA肾病患者,按照牛津分型标准重新读片,以血肌酐倍增、估算的肾小球率过滤(eGFR)下降50%或进入终末期肾衰竭为终点事件,采用单因素和多因素Cox回归模型分析病理改变与终点事件的相关性。结果 533例患者中位随访时间为39个月(12～263个月),复合终点事件发生率为5.07%。单因素分析结果显示,肾小管萎缩/间质纤维化以及小动脉病变与肾脏预后相关。多因素Cox回归分析结果显示,仅肾小管萎缩/间质纤维化为预后的独立危险因素。对病理指标作交互分析也未显示对预后的影响。结论在IgA肾病牛津分型的病理指标中,仅肾小管萎缩/间质纤维化为影响肾脏预后的独立危险因素。

Objective To validate the value of the Oxford classification of IgA nephropathy in predic- ting the renal outcome in Chinese population. Methods Retrospective study was done in patients with IgA ne- phropathy. All slides were re-assessed according to the Oxford classification of IgA nephropathy. The primary end point is doubling serum creatinine, or a 50% reduction in estimated glomerular filtration rate （eGFR） , or end-stage renal disease. Pathologic predictors for the progression to the end point were determined by univariate and multivariate Cox regression. Results Totally 533 patients were enrolled in the study. During the follow-up （median： 39 months; range： 12-263 months）, 5.07% of the patients reached the end point. While tubular atrophy and interstitial fibrosis and arterial/arteriolar lesion were associated with the endpoint in univariate anal- ysis, only the T score was predictive of the renal outcome in multivariate Cox regression. Combination of the patho- logic lesions had no impact on renal outcome. Conclusion According to the Oxford classification of IgA ne- phropathy, the degree of tubulointerstitial fibrosis is the only feature independently predictive of renal outcome.