IgA肾病牛津病理分类方法与Lee分级法的临床适用性比较  

Comparison of the clinical applicability of the Oxford classification and Lee′s classification for IgA nephropathy

作　　者：黄兰[1] 李英健[2] 刘艳红[1] 赵亚娟[1] 胡桂才[1] 朱菊平[1] 

机构地区：[1]承德医学院附属医院肾内科,河北承德067000 [2]承德医学院附属医院肿瘤外科,河北承德067000

出　　处：《重庆医学》2013年第10期1108-1110,共3页Chongqing medicine

摘　　要：目的比较牛津病理分类方法与Lee分级方法对IgA肾病病理分级的相关性,分析牛津病理分类方法中各病理指标与临床指标的相关性。方法收集该院IgA肾病患者282例,按牛津病理分类方法和Lee分级法分别对肾组织切片进行评分,比较两种病理分级方法间的相关性,及其与估算的肾小球滤过率(eGFR)和24h尿蛋白定量(24-UPro)的相关性。针对牛津病理分类方法中的4个病理指标分别进行评分,并分为M0组与M1组,E0组与E1组,S0组与S1组,T0组与T1/T2组。分别比较各组间年龄、血压、24-UPro、血尿酸、血肌酐、eGFR等临床资料。结果牛津病理分类方法与Lee分级呈正相关性(P<0.001),两种方法与eGFR均有负相关关系(P<0.001),而与24-UPro均无相关性(P>0.05)。牛津病理分类方法中M0组与M1组,E0组与E1组,在年龄、血压、24-UPro、血尿酸、血肌酐、eGFR等临床指标中,差异无统计学意义(P>0.05);S1组和T1/T2组的血尿酸、血肌酐水平高于S0组和T0组(P<0.05),而eGFR则低于S0组和T0组(P<0.001)。结论牛津病理分类方法与Lee分级方法有较好的相关性。肾组织学病变中,系膜细胞增生、内皮细胞增生为活动性病变,经治疗可逆转,而节段性肾小球硬化、肾小管萎缩/肾间质纤维化则为慢性化指标,可提示IgA肾病患者的预后。Objective To analyze the correlation between the Oxford classification and Lee′s classification,and to study the relationship between pathological variables of the Oxford classification and clinical indicators.Methods Clinical and pathological datas of 282 patients diagnosed as primary IgA nephropathy were collected.The Oxford classification and Lee′s classification were performed.Compare the correlation between the Oxford classification and Lee′s classification,the respective correlation of the two scoring methods and the estimated glomerular filtration rate（eGFR） and 24 hour urinary protein（24-UPro）.According to the pathological score of the Oxford classification,divide into four groups： M0 and M1,E0 and E1,SO and S1,T0 and T1/T2.These groups were corpared with age,blood pressure,24-UPro,blood uric acid,serum creatinine,eGFR,etc.Results The Oxford classification is positively correlated with Lee′s classification（P0.001）.There are significantly negative relationship between the two scoring methods and eGFR（P0.001）,but no correlation with 24-UPro（P0.05）.There were no significant difference in the age,blood pressure,24-UPro,serum uric acid,serum creatinine,eGFR between M0 and M1 group,E0 and E1 group（P0.05）.The serum uric acid and serum creainine of S1 group and T1/T2 group were higher than that of S0 group and T0 group（P0.05）,while the eGFR of S1 group and T1/T2 group were lower than that of S0 group and T0 group（P0.001）.Conclusion There is a positive relationship between the Oxford classification and Lee′s classification.The proliferation of mesangial cells and endothelial cells are activity lesions and could be reversed after treatment,while segmental glomerular sclerosis,tubular atrophy/renal interstitial fibrosis are chronicity index which could predict the prognosis of IgA nephropathy.

关 键 词：肾小球肾炎 IGA 牛津病理分类方法 Lee分级法 

分 类 号：R692.3[医药卫生—泌尿科学]