间质纤维化评分在不同病理类型所致的肾病综合征患者中的临床意义及其与肾脏预后的关系

The significance of interstitial fibrosis score in patients with nephrotic syndrome caused by different pathological types and its relationship with renal prognosis

目的分析间质纤维化评分在不同病理类型所致的肾病综合征患者中的临床意义及其与肾脏预后的关系。方法选取2016年5月至2018年9月本院收治的298例肾病综合征患者,包括经活检证实的微小病变肾病(MCD)患者92例、局灶节段性肾小球硬化(FSCS)患者114例膜性肾病(MN)患者56例和IgA肾病(IgAN)患者36例。间质纤维化(IF).肾小管萎缩(TA)和间质炎症(I)在数字化全幻灯片活检图像上由五位具有高度读者间一致性的病理学专家[类内相关系数(ICC)>0.8]进行量化(%)。多变量Cox比例风险回归模型用于评估IF与估算肾小球滤过率(eGFR)下降40%、终末期肾病(FSRD)以及蛋白尿完全缓解(CR)的相关性。结果IF与II(r=0.77,=0.59,P<0.0001)及肾小球硬化(GS)(r=0.80,r^(2)=0.64,P<0.001)高度相关。FSCS组IgAN组、MN组及MCD组IF的中位数(IQR)分别为18.21.7.1,差异均有统计学意义(P<0.001)。IF与基线eGFR(rho=-0.7,P<0.001)及蛋白尿(rho=0.2,P<0.001)之间具有相关性。在未经调整的Cox比例风险模型中,IF每增加10%,CR的风险比为0.73[95%C1:0.64~0.82,P<0.001],ESRD或eGFR较基线下降40%的风险比为1.32(95%C:1.21~1.45,P<0.001)。调整后,IF的百分比仍与ESRD或eGFR下降40%显著相关,但其与CR无相关性。结论IF的程度与不同类型的蛋白尿性肾小球疾病eGFR下降的风险具有相关性并可能在评估风险进展方面具有预测价值。

Objective To analyze the significance of interstitial fibrosis score in patients with nephrotic syndrome caused by different pathological types and its relationship with renal prognosis.Methods We studied 298 patients,including biopsied minimal change disease(M CD,92 cases),focal segular glomerular sclerosis(FSGS,114 cases),membranous nephropathy(MN,56 cases),and IgA nephropathy(IgA N,36 cases)from May 2016 to September 2018.Cortical interstitial fibrosis(IF),tubular atrophy(TA),and interstitial inflammation(II)were quantified on digitized full-slide biopsy images by five pathologists with high reader consistency(intra-class correlation coefficient>0.8)(%).Multivariate Cox proportional hazard regression models were used to assess IF was association with estimated glomenilar filtration rate(eG FR)reduction of 40%,end-stage renal disease(ESRD),and albuminuria complete remission(C R).Results IF was highly correlated with as(P<0.001)and D(P<0.001),IF medians varied from diagnosis:FSGS 17,IgAN 21,MN 7,MCD 1(P<0.001).IF was strongly correlated with baseline eGFR(P<0.001)and albuminuria(P<0.001),After adjusting for clinicopathologic diagnosis,age,GS,baseline proteinuria and eGFR,the risk ratio for each 10%increase in IF(P<0.001),but there was no significant correlation with CR.Conclusions The degree of IF is associated with the risk of decreased eGFR in different types of proteinuria glomerular disease,associated with inflammation and may be predictive in assessing the risk of progression.