牛津分类与国际小儿肾脏病研究组分级在评价儿童紫癜性肾炎预后中的应用  

Value of Oxford classification and ISKDC classification in the prognosis of children with Henoch-Schönlein purpura nephritis

作　　者：李雪倩 刘小荣[1] 姚兴凤[2] 张楠[1] 樊剑锋[1] 陈植[1] 孙嫱[1] 周楠[1] 孟群[1] 凌晨[1] 蒋也平 雷蕾 唐蒙蒙 张贺佳 李叶桐 Li Xueqian;Liu Xiaorong;Yao Xingfeng;Zhang Nan;Fan Jianfeng;Chen Zhi;Sun Qiang;Zhou Nan;Meng Qun;Ling Chen;Jiang Yeping;Lei Lei;Tang Mengmeng;Zhang Hejia;Li Yetong(National Center for Children's Health,Department of Nephrology,Beijing Children's Hospital,Capital Medical University,Beijing Key Laboratory of Pediatric Chronic Kidney Disease and Blood Purification,Beijing Children's Hemodialysis Center,Beijing 100045,China;National Center for Children's Health,Department of Pathology,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院肾病科儿童慢性肾脏病与血液净化北京市重点实验室,北京100045 [2]国家儿童医学中心首都医科大学附属北京儿童医院病理科,北京100045

出　　处：《中华肾脏病杂志》2020年第1期26-33,共8页Chinese Journal of Nephrology

基　　金：北京市科学技术委员会重点项目(D181100000118006);北京市科学技术委员会首都临床特色应用研究(Z161100000516106)。

摘　　要：目的探讨肾脏病理牛津分类(MESTC评分)与国际小儿肾脏病研究组(ISKDC)分级在评价儿童紫癜性肾炎临床病理表现、短期预后和临床转归中的价值。方法病例来自2018年1月至2018年12月期间于北京儿童医院肾病科住院、经肾脏活组织检查(肾活检)确诊为过敏性紫癜性肾炎的患儿。按照牛津分类与ISKDC分级对入选者肾活检标本进行病理评分。按照首发症状是否合并肾脏表现及MESTC评分、ISKDC分级分组,比较各组间患儿临床病理表现的差异。用非参数相关分析评估MESTC评分与ISKDC分级指标的相关性。采用Kaplan-Meier生存曲线及Log-rank检验比较两组患儿蛋白尿缓解的差异;单因素及多因素Cox回归方程法分析患儿蛋白尿缓解的影响因素。结果共纳入78例紫癜性肾炎患儿,男37例(47.4%),年龄(10.4±2.9)岁。依据MESTC评分与ISKDC分级分组的组间比较结果显示,内皮细胞增生(E1,P=0.008)、节段硬化(S1,P=0.015)及ISKDCⅢ级(P=0.041)组肾病水平蛋白尿患儿比例较E0、S0和ISKDCⅡ级组高;E1(P=0.015)、新月体形成(C1&C2,P=0.025)以及ISKDCⅢ级(P=0.017)组接受激素冲击治疗患儿比例高。Kaplan-Meier生存分析结果显示,C2组患儿较C0&C1组更难达到蛋白尿缓解(P=0.026)。多因素Cox回归模型分析结果提示,牛津分类评分为C2(HR=0.143,95%CI 0.020~1.046,P=0.055)可能是紫癜性肾炎患儿蛋白尿缓解的危险因素,P值为临界值。结论ISKDCⅢ级以及牛津分类中的E1、S1型紫癜性肾炎患儿更易表现为肾病水平蛋白尿。牛津分类中C2可能是患者短期蛋白尿缓解的危险因素。Objective To analyze the Oxford classification(MESTC)and the International Study of Kidney Disease in Children(ISKDC)classification for evaluating the clinical manifestations,histological lesion and short-term prognosis of children with Henoch-Schönlein purpura nephritis(HSPN).Methods According to the Oxford classification and ISKDC classification,the histological lesions of children with HSPN diagnosed by renal biopsy from Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to December 2018 were re-evaluated.The renal biopsy specimens of the selected subjects were scored according to the Oxford classification and the ISKDC classification.According to whether the first symptom was combined with renal performance,MESTC score and ISKDC classification,children were grouped.The differences in clinicopathological manifestations between the groups were compared.Correlation between MESTC and ISKDC grades was analyzed by nonparametric test rank correlation.Kaplan-Meier survival curve and Log-rank test were used to compare the difference of proteinuria remission rate between the two groups.Univariate and multivariate Cox regression equations were used to analyze the influencing factors of the proteinuria remission rate.Results A total of 78 children with HSPN were enrolled.There were 37 male patients(47.4%)with age of(10.4±2.9)years.When the patients were divided according to MESTC scores and ISKDC classification,the results showed that the proportion of children with nephrotic-range proteinuria in the group of endocapillary hypercellularity(E1,P=0.008),segmental glomerulosclerosis(S1,P=0.015)and ISKDCⅢ(P=0.041)was higher than that of E0,S0 and ISKDCⅡgroups.The proportion of children with E1(P=0.015),crescents(C1&C2,P=0.025)or ISKDCⅢ(P=0.017)that had been treated with high-dose methylprednisolone was higher.The result of Kaplan-Meier survival curve showed more difficult for proteinuria remission in children with C2 are than C0&C1 group(P=0.026),while no difference were found when

关 键 词：紫癜 过敏性 肾小球肾炎 活组织检查 牛津分类 ISKDC分级 预后 

分 类 号：R726[医药卫生—儿科]