原发性IgA肾病不同病理分级方法与临床指标及预后的关联性分析

    Correlation analysis of clinical parameters and prognosis in different pathological grades of primary IgA nephropathy

      摘要
    • 摘要: 目的 探讨原发性IgA肾病不同病理分级方法与临床指标的相关性及对预后的判断。方法 收集明确诊断为原发性IgA肾病且随访大于12个月的185例患者的病例资料，分别比较牛津分型、Lee分级及Hass分型与临床指标的相关性以及对预后的判断。结果 （1）牛津分型的系膜细胞增生（M）、内皮细胞增生（E）、节段性小球硬化/黏连（S）、肾小管萎缩/间质纤维化（T）、新月体形成（C）及Lee分级、Hass分型均与血肌酐（serum creatinine，Scr）、24 h尿蛋白定量（24 hour urinary protein quantity，24h-UP）及估算肾小球滤过率（estimated glomerular filtration rate，eGFR）的差异有统计学意义（P<0.05）；牛津分型的M、S、T与血尿酸（uric acid，UA）的差异有统计学意义（P<0.05）；牛津分型的T及Lee分级与平均动脉压（mean arterial pressure，MAP）差异有统计学意义（P<0.05）。相关性分析得出牛津分型的T与eGFR负相关关系最强（r=-0.558，P<0.001），与尿素氮（blood urea nitrogen，BUN）、Scr、UA正相关关系最强（r=0.424、r=0.554、r=0.407，P均<0.001）；Lee分级与血红蛋白（hemoglobin，Hb）、白蛋白（albumin，Alb）负相关关系最强（r=-0.217、r=-0.367，P=0.003、P<0.001），与24h-UP、MAP正相关关系最强（r=0.312、r=0.202，P<0.001、P=0.006）。（2）牛津分级M、E、S组间的肾脏累积生存率差异无统计学意义（P>0.05）；T2组的肾脏累积生存率较T0组及T1组低（P<0.05）；C2组的肾脏累积生存率较C0组及C1组低（P<0.05）。Lee分级与Hass分级的Ⅰ、Ⅱ、Ⅲ级/型间两两比较及Ⅳ、Ⅴ级/型间的肾脏累积生存率差异无统计学意义（P>0.05），Ⅳ、Ⅴ级/型的肾脏累积生存率较Ⅰ、Ⅱ、Ⅲ级/型低（P<0.05）。结论 原发性IgA肾病病理分级与临床指标具有一定的相关性，其中牛津分型的T在评价肾功能改变方面临床适用性最强，对于伴有血压升高、贫血改变、白蛋白降低及蛋白尿的IgA肾病患者更适宜使用Lee分级进行病理评价。肾小管萎缩/间质纤维化>50%、新月体形成>25%的患者及Lee分级、Hass分型为Ⅳ、Ⅴ级/型的患者预后较差。

       

      Abstract: Objective To explore the correlation between different pathological grading methods and clinical parameters of primary IgA nephropathy and predicate the prognosis. Methods Case data were collected for 185 patients with primary IgA nephropathy and followed up for over 12 months to compare the correlation of clinical parameters with Oxford,Lee and Hass classifications. Results The differences of mesangial cell hyperplasia(M),endothelial cell hyperplasia(E),segmental sclerosis of ball/adhesion(S),renal tubular atrophy/fibrosis(T),crescent formation(C) in Oxford,Lee and Hass classifications and serum creatinine(Scr),24 hours urinary protein quantitative(24h-UP) and estimated glomerular filtration rate(eGFR) were statistically significant(P<0.05);The differences of M/S/T in Oxford classification and serum uric acid(UA) were statistically significant(P<0.05). Statistically significant differences existed between T of Oxford classification,Lee grade and mean arterial pressure(MAP) (P<0.05). The negative correlation between T of Oxford type and eGFR was the strongest(r=-0.558,P<0.001). And the positive correlation between T of Oxford type and urea nitrogen(BUN),Scr and UA was the strongest(r=0.424,r=0.554,r=0.407,P<0.001,P<0.001,P<0.001). The strongest negative correlation existed between Lee classification and hemoglobin(Hb),albumin(Alb) (r=-0.217,r=-0.367,P=0.003、P<0.001) and the strongest positive correlation existed between Lee classification and 24h-UP,MAP(r=0.312,r=0.202,P<0.001,P=0.006). No significant difference existed in renal cumulative survival rate among Oxford grade M,E and S groups(P>0.05);renal cumulative survival rate of T2 group was lower than that of T0/T1 group(P<0.05);renal cumulative survival rate of C2 group was lower than that of C0/C1 group(P<0.05). No significant difference existed in cumulative renal survival rate between Lee grade and Hass grade I/Ⅱ/Ⅲ(P>0.05). However,cumulative renal survival rate of grade IV/V was lower than that of grade I/I/Ⅲ(P<0.05). Conclusion The pathological grade of primary IgA nephropathy is correlated with clinical parameters. Oxford T classification has the strongest clinical applicability in the evaluation of renal function changes. Lee classification is more suitable for IgA nephropathy patients with IgA nephropathy accompanied by elevated blood pressure,anemia,decreased albumin and proteinuria. The prognosis of patients with tubular atrophy or interstitial fibrosis >50%,crescent formation >25%,Lee grade and Hass grade IV/V are poor.

       

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