紫癜性肾炎肾小球血管病变病理分级的初步探讨

A preliminary study on the pathological grading of glomerular vascular lesions in Henoch-Sch?lein purpura nephritis

目的探讨采用紫癜性肾炎(HSPN)肾小球血管病变百分比评分(GVLPS)系统分级评估HSPN血管炎性病变的可靠性。方法收集陆军军医大学附属新桥医院2012年1月-2015年8月确诊的140例HSPN患者肾活检标本和临床资料进行回顾性分析,按GVLPS分级标准分析每例肾活检标本。GVLPS计算公式为:血管内皮细胞增殖、血管玻璃样变、血管纤维素样坏死、内皮下嗜复红物沉积、细胞新月体、纤维新月体、节段性硬化或球性硬化症的肾小球数量/全部被观察的肾小球数量×100%。按GVLPS值分为HG1至HG4共4个等级:GVLPS<25%为HG1,25%≤GVLPS<50%为HG2,50%≤GVLPS<75%为HG3,GVLPS≥75%为HG4。以20例正常肾组织标本作为对照。分析GVLPS与ISKDC分级、肾小球浸润的CD2^+和CD68^+炎性细胞数、24h尿蛋白、肾小球滤过率(eGFR)、尿红细胞数和血清白蛋白(ALB)的相关性。结果根据GVLPS分级标准,140例患者的肾活检标本中,HG1 37例(26.4%),HG2 46例(32.9%),HG3 40例(28.6%),HG4 17例(12.1%)。GVLPS系统分级较ISKDC分级更能反映血管早期病变的严重程度。GVLPS与ISKDC分级、24h尿蛋白、尿红细胞数和肾小球浸润的炎性细胞数呈明显正相关,与eGFR、ALB呈负相关。结论 GVLPS评分能较准确地反映HPSN血管损伤,弥补了ISKDC分级的不足,为今后大样本研究HSPN提供了数据支持。

Objective To validate the glomerular vascular lesions percentage score（GVLPS） system in renal vascular lesions of Henoch-Sch？lein purpura nephritis（HSPN） in a single-center cohort. Methods Clinical and renal histopathological data of 140 patients with renal biopsy-proven HSPN, admitted in Xinqiao Hospital of Army Medical University from Jan. 2012 to Aug. 2015, were retrospectively analyzed and reclassified according to the GVLPS system. The GVLPS [number of glomeruli with endothelial cell proliferation, hyalinosis, cellulose necrosis, subendothelial hyaline deposits, cellular crescents, fibrous crescents,segmental sclerosis or global sclerosis/number of total obtained glomeruli×100%] was evaluated in each patient and classified into histopathological grades（HG）： HG1（25%）, HG2（≥25%, 50%）, HG3（≥50%, 75%） and HG4（≥75%, ≤100%）.20 case of normal renal tissues were assigned as control groups. The associations were analyzed of GVLPS（HG） with ISKDC（International study group of Kidney disease in childhood） pathology classification, CD20-＋ and CD68-＋ positive cells per glomeruli,24 h proteinuria, hematuria, eGFR（epidermal growth factor receptor） and serum albumin. Results According to GVLPS, 140 patients were categorized as HG1 in 37（26.4%）, HG2 in 46（32.9%）, HG3 in 40（28.6%） and HG4 in 17（12.1%）. It was certified that GVLPS system is more effective than ISKDC classification in evaluating the renal vascular lesions of HSPN, especially in early HSPN. Moreover, the GVLPS was positively correlated with ISKDC classification, CD20-＋ and CD68-＋ positive cells per glomeruli,24 h proteinuria and hematuria, and negatively correlated with eGFR, serum albumin. Conclusions TheGVLPS system is more sensitive than ISKDC classification in evaluating the renal vascular lesions of HSPN, and makes up for the lack of ISKDC classification. Further study should be performed for assessing their associations with clinical and pathological data, using a large cohort of patients with HSPN.