IgA肾病牛津病理分型与临床分析

目的探讨IgA肾病牛津病理分型与临床的关系。方法对424例原发性IgA肾病的肾组织病理切片采用牛津病理分型标准重新分型,对4个病理指标：系膜细胞增生（M）,毛细血管内细胞增生（E）,节段性小球硬化或黏连（S）,肾小管萎缩或间质纤维化（T）进行评分并分组,分为M0组与M1组,E0组与E1组,S0组与Sl组,T0、T1与T2组,分别比较各组间患者的年龄、平均动脉血压（MAP）、24 h尿蛋白定量（UPRO）、血清肌酐水平（Scr）、估计肾小球滤过率（eGFR）、胆固醇（CH）及甘油三脂（TG）等临床资料。结果①各病理指标的分布情况为M0（14.4%）、M1（85.6%）、E0（99.06%）、E1（0.94%）,S0（79.25%）、S1（20.75%）、T0（78.54%）、T1（10.14%）、T2（11.32%）,病理类型以M1E0S0T0多见。②临床资料显示,424例lgA肾病患者临床表现以血尿伴蛋白尿最常见,为213例（50.23%）,此外,也可见为肾病综合征103例（24.29%）、单纯蛋白尿85例（20.05%）、单纯血尿23例（5.42%）、合并高血压62例（14.62%）、肾功能不全78例（18.4%）、高胆固醇血症37例（8.73%）、高甘油三酷血症70例（16.5%）。③病理指标与临床资料比较显示,尿蛋白定量与系膜细胞增生有关（P〈0.05）;平均动脉血压、尿蛋白定量、血清肌酐水平、肾小球滤过率与节段性小球硬化或黏连、肾小管萎缩或间质纤维化有关（P〈0.05）。结论牛津病理指标中M、S、T与IgA肾病临床指标有关,对IgA肾病的治疗和预后评价有很好的指导作用。

Analysis of the Oxford classification and clinical characteristics of 424 cases of IgA nephropathy

Objective To investigate the relationship of Oxford classification and clinical characteristics of IgA nephropathy. Methods Retyping 424 cases of primary IgA nephropathy histopathological with classification criteria of oxford pathology. Scored four Pathological indicators as Mesangial cell proliferation（ M）,endocapillary hypereellularity（ E）,segmentalsclerosis or adhesions（ S）,Tubular atrophy / interstitial fibrosis（ T）,and grouped for group M0 and M1,group S0 and S1,group T0,T1 and T2. The E cases didn＇t group because of fewer cases. The age,mean arterial pressure（ MAP）,24- hour urinary protein excretion（ UPRO）,serum creatinine（ Scr）,estimated glomerular filtration rate（ eGFR）,cholesterol（ CH）,triglycerides（ TG） in different groups were compared. Results The distribution of various pathological parameters were M0（ 14. 4%）,M1（ 85. 6%）,E0（ 99. 06%）,E1（ 0. 94%）,S0（ 79. 25%）,S1（ 20. 75%）,T0（ 78. 54%）, T1（ 10. 14%） and T2（ 11. 32%）. Clinical data showed 424 cases of patients with clinical manifestations of lgA nephropathy,hematuria with proteinuria type was the most common in 213 cases（ 50. 23%）,followed by nephrotic syndrome 103 cases（ 24. 29%）,proteinuria alone in 85 cases（ 20. 05%）,hematuria 23 cases（ 5. 42%）,hypertension in 62 cases（ 14. 62%）,renal dysfunction,78 cases（ 18. 4%）,hypercholesterolemia 37 cases（ 8. 73%）,hypertriglyceridemia 70 cases（ 16. 5 %）. Pathological and clinical data comparison showed the urinary protein excretion was associated with mesangial cell hyperplasia（ P 0. 05）. Mean arterial pressure,urinary protein,serum creatinine,glomerular filtration rate were associated with segmental sclerosis or adhesions,tubular atrophy and interstitial fibrosis（ P 0. 05）. Conclusion Pathology indicators M,S and T of Oxford classification are associated with IgA nephropathy indicators,and it has a good role in guiding the evaluation of the treatment and prognosis of IgA nephropathy.