原发性IgA肾病临床与IgA肾病牛津分类的相关性

Correlation of the clinical features and the Oxford pathological type of primary IgA nephropathy

目的:探讨IgA肾病牛津分类与临床指标之间的相关性,为进一步指导治疗、判断预后提供依据。方法:选取2010年7月至2012年6月在温州医科大学附属第一医院经肾活检确诊的原发性IgA肾病患者205例,结合其临床和病理资料,按不同条件分组,进行临床病理分析。结果:按IgA肾病牛津分类对患者的病理资料进行评价,病理损伤以局灶节段性肾小球硬化(S1)多见,病理类型以系膜细胞增多(M0型)节段性肾小球硬化(S1型)毛细血管内细胞增多(E0型)肾小管萎缩/间质纤维化(T0型)即M0S1E0T0多见。患者临床表现与病理之间的相关性分析:①系膜细胞增多(M)、毛细血管内细胞增多(E)、肾小管萎缩/间质纤维化(T)与肾活检时蛋白尿高度相关(P<0.05);②毛细血管内细胞增多(E)、肾小管萎缩/间质纤维化(T)、肾微小动脉病变与肾活检时平均动脉压(MAP)升高相关(P<0.05);③系膜细胞增多(M)、肾小管萎缩/间质纤维化(T)与肾活检时血肌酐升高相关(P<0.01)。结论:原发性IgA肾病临床表现多样,病理类型以M0S1E0T0多见。原发性IgA肾病临床表现与IgA肾病牛津分类之间具有相关性,IgA肾病牛津分类与临床特点有关,可以有效地指导临床。

Objective： To study the correlation between clinical features and the Oxford pathological classification in IgA nephropathy （IgAN）. Methods： Two hundred and five IgAN patients from the First Affiliated Hospital of Wenzhou Medical College which had been diagnosed by renal biopsy from July 2010 to June 2012 were reviewed. All of the pathological and clinical data were analyzed with SPSS 16.0. Results： Segmental glomerulosclerosis was the main pathological damage and M0S1E0T0 was the major type in renal histology. During the patient biopsy, the correlation was presence as follows： ① The proteinuria was related to renal pathological findings （including the mesangial proliferation, endocapillary proliferation, tubular atrophy/interstitial fibrosis） （P 〈0.05）; ② The mean artery pressure （MAP） elevation was related to the renal pathology, such as endocapillary proliferation, tubular atrophy/interstitial fibrosis, renal small artery lesions （P〈0.05）; ③The degree of tubular atrophy/interstitial fibrosis and mesangial proliferation which most significantly correlated with serum creatinine. Conclusion： Clinical manifestations of IgA nephropathy are various, M0S1E0T0 is the most common type in renal histology, The correlation between clinical manifestations and the Oxford pathological classification of IgA nephropathy is presence during the time of renal biopsy.