IgA肾病牛津病理分型方法与Lee分级方法的比较及其临床病理研究

Comparison of the Oxford classification and Lee's classification for IgA nephropathy and study of clinicopathologiical features of IgA nephropathy

目的:研究IgA肾病新评价标准牛津病理分型方法与Lee分级方法的相关性,探讨牛津分型病理指标与IgA肾病临床指标的关系。方法:回顾分析107例经肾活检确诊的原发性IgA肾病患者的病理资料,分别按照Lee分级标准和IgA肾病牛津分型标准进行评价,比较两种病理分型方法间的相关性,及与血尿素氮(BUN)、血清肌酐(Scr)、肾小球滤过率(eGFR)和24小时尿蛋白定量(24 h-UPro)等临床指标的相关性;根据牛津分型中各个病理指标进行分组,分为M0组与M1组,E0组与E1组,S0组与S1组,T0、T1与T2组,无新月体、新月体<25%组和新月体25%~75%组,<25%球性硬化组和≥25%球性硬化组,分别比较各分组间的BUN、Scr、eGFR、24 h-UPro等临床指标。结果:IgA肾病牛津病理分型与Lee分级呈正相关,两种方法均与BUN、Scr正相关,与eGFR负相关,而与24 h-UPro均无相关性。牛津病理评分指标M、E、S、T分组,新月体分组和球性硬化分组间IgA肾病患者eGFR有明显差异并呈负相关;M0组与M1组间在BUN、Scr、血尿酸(UA)中有明显差异并呈正相关,其余BMI、MAP、血脂(甘油三脂、胆固醇)等无明显差异。E0组与E1组间BUN、BMI有明显差异并呈正相关,其余Scr、血脂等无明显差异。S0组与S1组间BUN、Scr、总胆固醇有明显差异并呈正相关,其余BMI、MAP等无明显差异。T0、T1与T2组间BUN、Scr、MAP、UA有明显差异并呈正相关,而BMI、血脂等无明显差异。新月体分组间BUN、Scr有明显差异并呈正相关,其余UA、血脂等无明显差异。球性硬化分组间BUN、Scr、MAP、UA有明显差异并呈正相关,其余BMI、血脂等无明显差异。T分组间和球性硬化分组间24 h-UPro有明显差异并呈正相关,其余M、E、S分组及新月体分组间无明显差异。结论:IgA肾病牛津病理分型方法与Lee分级方法具有良好的相关性,对IgA肾病具有临床适用性。牛津病理分型病理指标系膜细胞增生、内皮细胞增生为活动性病变,经治疗可逆转,而节段性肾小球硬化、肾小管萎缩/肾间质纤维化则为慢性化指标,可提示IgA肾病患者的预后。

Objective： To study the correlation between the Oxford classification and Lee~ classification for IgA nephropa- thy（IgAN） and to study the relationship between pathological variables of the Oxford classification and clinical indicators. Methods：Clinical and pathological datas of 107 patients diagnosed as primary IgAN were collected. The Oxford classifi- cation and Lee＇s classification were performed. Compare the correlation between the two scoring methods, and the clinical indicators were quantitatively compared such as blood urea nitrogen（BUN） ,serum creatinine（Scr） ,estimated glomerular filtration rate （eGFR） and 24 hour urinary protein（24-Upro） etc. According to the pathological score of the Oxford classi- fication, these cases were divided into different groups ： M0 and M1, E0 and E1, SO and S1, T0 ,T1 and T2, no cresent ,Cre- sent 〈 25% and Cresent 25% - 75%, glomerulosclerosis 〈 25% and glomerulosclerosis≥ 25%. These groups were com- pared with BUN ,Scr,eGFR and 24-Upro etc. Results：The Oxford classification was positively correlated with Lee~ classi- fication. There were significant negative relationship between the two scoring methods and eGFR, but no correlation with 24-Upro. There were negative relationship in eGFR between M0 and M1 groups,E0 and E1 groups,SO and S1 groups,a- mong T0,T1 and T2 groups, cresent groups and between glomerulosclerosis groups we metiond above. There were signifi-cent diffemence and positive correlation in BUN,Scr and blood uric acid（UA） between M0 and M1 groups,but no differ- nence in BMI,MAP and blood fat（ triglycerid,total cholesterol）. And there were significent differnence and positive corre- lation in BUN and BMI between E0 and E1 groups, but no differnence in Scr and blood fat etc. SO group was positive cor- related with S1 group in BUN,Scr and total cholesterol,but no differnence in BMI and blood fat etc. In BUN,Scr,MAP and UA,there were positive correlation among TO ,T1 and T2 groups but no differnence in BMI and blood fat etc. There were positive relationship among cresent groups in BUN and Scr,but no differnence in UA and blood fat etc. And also there were positive relationship between glomerulosclerosis groups in BUN,Scr, MAP and UA, but no differnence in BMI and blood fat etc. In 24-Upro, there are positive relationship among TO,T1 and T2 groups and beteween glomerulosclerosis groups, but no correlation between M0 and M1 groups, E0 and E1 groups, SO and S1 groups and among cresent groups. Conclusion：There is positive relationship between the Oxford classification and Lee^lassification, and the Oxford classifi- cation is suitable for clinical use. The proliferation of mesangial cells and endothelial cells are active lessions and could be reversed after treatment. While segmental glomerular sclerosis, tubular atrophy/renal interstial fibrousis are chronic index which could prdict the prognosis of IgAN.