抗中性粒细胞胞质抗体相关性肾炎组织学分型的研究进展

Key advances in the histopathologic classification to ANCA-associated glomerulonephritis

抗中性粒细胞胞质抗体(ANCA)相关性肾炎是急进型肾小球肾炎最常见的原因,肾活检是确诊本病的金标准。肾活检病理检查在制定ANCA相关性肾炎治疗方案和判断预后中具有重要临床价值,但ANCA相关性肾炎的病理学分型在很长时间内未达成共识。2010年制定的ANCA相关性肾炎病理分型标准(EUVAS分型)将其分为局灶型、新月体型、混合型以及硬化型。随后有多项研究证实此分型对ANCA相关性肾炎肾预后的预测价值。但不同研究中各种病理类型的肾存活率差异显著,ANCA相关性肾炎病理分型对治疗的指导价值及更精确判断预后仍需进一步研究。文章主要就ANCA相关性肾炎最新病理分型的临床意义、相关病理特征定义及该分型的相关验证研究进行综述。

Anti-neutrophil cytoplasmic antibody （ ANCA）-associated glomerulonephritis is the most common cause of rapidly progressive glomerulonephritis worldwide , and the renal biopsy is not only the gold standard for establishing the diagnosis ,but also help-ful to judge the prognosis in clinical practice .In 2010,Berden et al presented a pathologic classification which proposed four general categories of lesions：Focal, crescentic, mixed, and sclerotic.And then, several validation studies proved the prognostic value of this classification.However, the difference of renal survival is large in various pathological types among different studies , so it needs more studies to develop its prognostic value .This review mainly focuses on clinical significance , definition of pathological feature , and vali-dation study about this classification .