运用牛津分型联合肾小球新月体病变类型评析儿童与成人IgA肾病临床病理特点  

Clinicopathological features of IgA nephropathy in children and adults assessed by the Oxford clas⁃sification and glomerular crescent lesion typing

作　　者：白秋宇 杨晓青[1,2] 董丽雯 刘萌萌 谢格格 黄岩杰 Bai Qiu-yu;Yang Xiao-qing;Dong Li-wen;Liu Meng-meng;Xie Ge-ge;Huang Yan-jie(Pediatric Hospital,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;College of Pediatrics,Henan University of Chinese Medicine,Zhengzhou 450046,China;Department of Traditional Chinese Medicine,Shanghai Children’s Hospital&Shanghai Chil-dren’s Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]河南中医药大学第一附属医院儿科医院,郑州450000 [2]河南中医药大学儿科医学院,郑州450046 [3]上海市儿童医院,上海交通大学医学院附属儿童医院中医科,上海200062

出　　处：《临床肾脏病杂志》2025年第3期208-214,共7页Journal Of Clinical Nephrology

基　　金：2021年度国家自然科学基金面上项目(82174187);河南省科学技术厅中原科技创新领军人才项目(234200510028);河南省中医药学科领军人才项目[豫卫中医函(2021)8号]。

摘　　要：目的 结合牛津分型,将新月体病变细分为细胞性新月体、纤维细胞性新月体和纤维性新月体,明确儿童与成人IgA肾病(IgA nephropathy,IgAN)的临床病理特点。方法 回顾性收集2012年1月1日至2022年12月31日间在河南中医药大学第一附属医院行肾活检病理确诊的168例儿童IgAN和381例成人IgAN患者的临床病理资料。将成人组细分为青年组和中老年组,比较儿童组和青年组、中老年组临床分型、病理指标之间的差异和关联。结果 3组患者临床分型的统计结果显示,与青年组、中老年组相比,儿童组中肾病综合征型比例较高(37.50%比11.99%、11.24%,63例比35例比10例);与儿童组、中老年组相比,青年组血尿伴蛋白尿型比例较高(43.49%比32.74%、29.21%,127例比55例比26例);与儿童组、青年组相比,中老年组慢性肾炎型比例较高(53.93%比4.17%、37.67%,48例比7例比110例)。按照牛津分型,儿童IgAN患者出现肾小球系膜细胞增生(76.19%比60.37%,128例比230例)、内皮细胞增生(45.83%比13.65%,77例比52例)、细胞性新月体比例(50.00%比30.71%,84例比117例)高,青年组和中老年组肾小球节段硬化(69.82%比44.64%,266例比75例)、纤维性新月体(18.90%比8.93%,72例比15例)、肾小管萎缩/间质纤维化(29.40%比2.39%,112例比4例)比例高,差异具有统计学意义(P<0.05)。24 h尿蛋白定量与细胞性新月体百分比、总的细胞性新月体和纤维细胞性新月体百分比和内皮细胞增生百分比呈中度正相关(r=0.65,r=0.56,r=0.41,P<0.05);eGFR与肾小管萎缩/间质纤维化中度负相关(r=-0.61,P<0.05)。结论 儿童IgAN以急性肾小球病变为主,肾病综合征型是主要的临床类型;成人慢性肾小球、肾小管间质和血管病变是慢性肾炎型形成的病理基础;牛津分型中将新月体病变分为细胞性新月体、纤维细胞性新月体和纤维性新月体分别进行评分更具有临床指导意义。Objective To clarify the clinicopathological features of immunoglobulin A nephropa-thy(IgAN)in children and adults by categorizing crescentic lesions into cellular crescents,fibrocellular crescents and fibrous crescents based on the Oxford classification.Methods Clinicopathological data of 168 cases of pediatric IgAN(children group)and 381 cases of adult IgAN pathologically confirmed by re-nal biopsy between January 1,2012 and December 31,2022 in the First Affiliated Hospital of Henan Uni-versity of Chinese Medicine were retrospectively collected.Adult IgAN patients were subdivided into the youth group and the middle-aged and older adult group.The differences and correlations of clinical classi-fication and pathological indexes among children group,youth group and middle-aged and older adult group were compared.Results The statistical results of clinical classification in the three groups showed that the proportion of nephrotic syndrome type(37.50%vs 11.99%vs 11.24%,63 cases vs 35 cases vs 10 cases)in the children group was significantly higher than that of the youth group and the middle-aged and older adult group(P<0.05).The proportion of hematuria with proteinuria(43.49%vs 32.74%vs 29.21%,127 cases vs 55 cases vs 26 cases)was significantly higher in the youth group than that of the chil-dren group and the middle-aged and older adult group(P<0.05).The proportion of chronic nephritis type(53.93%vs 4.17%vs 37.67%,48 cases vs 7 cases vs 110 cases)was significantly higher in the middle-aged and older adult group than that of the children group and the youth group(P<0.05).According to the Oxford classification,significantly higher proportions of glomerular mesangial cell proliferation(76.19%vs 60.37%,128 cases vs 230 cases),endothelial cell hyperplasia(45.83%vs 13.65%,77 cases vs 52 cases)and cellular crescent(50.00%vs 30.71%,84 cases vs 117 cases)were seen in the children group than the remaining two groups,and significantly higher proportions of glomerular segmental sclero-sis(69.82%vs 44.64%,266 cases vs 75 cases)

关 键 词：儿童 成人 IGA肾病 新月体 

分 类 号：R69[医药卫生—泌尿科学]