牛津病理分型在儿童紫癜性肾炎评估中的价值

Value of Oxford pathological classification in children with Henoch-Schönlein purpura nephritis

目的探讨IgA肾病(IgAN)牛津分型在评估紫癜性肾炎(HSPN)临床及预后中的应用价值。方法收集2014年1月—2019年2月经临床及肾活检确诊为HSPN患儿的临床病理资料,按照IgAN牛津分型分组,比较牛津分型5个病理指标与HSPN临床表现、预后的关系。结果共收集102例HSPN患儿,男55例、女47例,发病年龄(8.72±2.31)岁。根据牛津分型,分为系膜细胞增生(M189例、M013例)、内皮细胞增生(E162例、E040例)、肾小球节段硬化/粘连(S139例、S063例)、肾小管/间质病变(T1/T 237例、T065例)以及新月体形成(C1/C 239例、C063例)。M、E、S、C病变与国际儿童肾脏病研究组(ISKDC)HSPN分级具有相关性(P<0.05)。与E0、C0组相比,E1、C1/C2组血尿和蛋白尿型比例较低;与E0组相比,E1组肾病综合征型比例较高,差异均有统计学意义(P<0.05)。E病变与蛋白尿之间,S、T病变与肉眼血尿之间具有相关性;C病变与高血压、肉眼血尿、蛋白尿之间均具有相关性,差异有统计学意义(P<0.05)。M1组的尿素氮高于M0组,E1组24小时尿蛋白定量高于E0组,S1组尿素氮高于S0组,T1/T2组血尿酸和血肌酐均高于T0组,C1/C2组血尿酸、血肌酐以及24小时尿蛋白定量均高于C0组,差异均有统计学意义(P<0.05)。多因素Ordinal回归分析显示,5个病理指标中,E、T、C病变与预后相关(P<0.05)。结论牛津病型分型与HSPN患儿的各临床指标、预后具有不同程度的相关性,有一定的临床应用价值。

Objective To evaluate the value of the five pathological indexes(MESTC)of Oxford classification in clinical indicators and prognosis of Henoch-Schönlein purpura nephritis(HSPN)in children.Methods The clinicopathological data of children with HSPN diagnosed by clinical and renal biopsy from January 2014 to February 2019 were collected.Pathology reports and other data were then reclassified according to the Oxford pathological classification by two professional nephropathologists.The correlations between the five indicators of Oxford classification and clinical indicators and prognosis in children with HSPN were analyzed.Results A total of 102 children with HSPN were collected,including 55 males and 47 females,with an average age of onset of 8.72 years(3.9-15 years).According to the Oxford typing score,they were divided into mesangial hypercellularity(M)(89 cases of M 1 and 13 cases of M 0),endothelial hypercellularity(E)(62 cases of E 1 and 40 cases of E 0),segmental glomerulosclerosis(S)(39 cases of S 1 and 63 cases of S 0),tubular/interstitial lesions(T)(37 cases of T 1/T 2 and 65 cases of T 0),and crescent(C)(39 cases of C 1/C 2 and 63 cases of C 0).M,E,S and C lesions were correlated with International Study of Kidney Disease in Children(ISKDC)classification(P<0.05).The proportion of hematuria proteinuria in E 1 and C 1/C 2 groups was lower than that in the E 0 and C 0 groups;the proportion of nephrotic syndrome type was higher in the E 1 group than in the E 0 group,and differences were statistically significant(P<0.05).E lesion was correlated with proteinuria,S and T lesions were correlated with gross hematuria.C lesion were correlated with hypertension,gross hematuria,and proteinuria,and all showed significant difference(all P<0.05).Urea nitrogen in group M 1 was higher than that in group M 0,urine protein in group E 1 was higher than that in group E 0,urea nitrogen in group S 1 was higher than that in group S 0,uric acid and creatinine in group T 1/T 2 were all higher than that in group T 0,and uric acid,creatinine and urine protein in group C 1/C 2 were all higher than that in group C 0,and differences were all significant(all P<0.05).E,T,C lesions were associated with prognosis(P<0.05).Conclusion The MESTC pathology are correlated with various clinical indicators and prognosis of children with HSPN, which suggested that the Oxford classification has certainclinical application value in children with HSPN.