牛津分类判断IgA肾病患者预后的临床分析

Predicting prognosis of patients with IgA nephropathy using the Oxford Classification as a predictor

目的:评价牛津分类临床与病理的相关性。方法:回顾分析我院经病理证实的IgA肾病患者共145例的临床资料,根据牛津分类比较初始活检时与随访结束时的各项指标。结果:活检时,肾小球膜分数M1(>0.5)患者尿蛋白高于M0(≤0.5)患者,差异具有统计学意义(P<0.05);有节段性肾小球硬化症(S1)患者尿蛋白高于S0患者,差异具有统计学意义(P<0.05);随着肾小管萎缩/间质纤维化(T)程度增加,接受免疫抑制剂者亦增加;随着T的严重性降低,肾小球滤过率(eGFR)也随之降低,差异具有统计学意义(P<0.05);T可判断是否发展成为终末期肾病、eGFR能否降低50%。结论:牛津分类是一种能预测预后的简便方法,但还需大样本随机临床研究验证。

Objective：To evaluate the pathologic relevance of the Oxford classification.Methods： To review the renal pathology archives from January 2005to December 2012and enrolled 145patients, who were diagnosed as having IgAN and were available for further clinicopathologic analysis.The clinical and laboratory findings at the time of biopsy were compared with those at the end of the follow-up according to the Oxford classification.Results：At the time of biopsy,the proteinuria in patients with M1was more than that of M0（P0.05）.At the time of biopsy,the proteinuria of patients with S1was greater than that of S0patients（P0.05）.At the end of follow-up period,the number of patients who received immuno-suppressants was increased as the grade of T increased（P0.05）.At the end point of the followup,the estimated glomerular filtration rate（eGFR）decreased as the grade of T increased（P0.05）. Levels of tubular atrophy/interstitial fibrosis were predictive for survival from end-stage renal disease or of having a 50%reduction of eGFR.Conclusion：The Oxford classification is a simple method for predicting prognosis,but large scaled and controlled studies are needed to prove the overall superiority of the Oxford classification.