原发性免疫球蛋白A肾病患者临床、病理研究

目的 探讨原发性免疫球蛋白A肾病Primary Immunoglobin A nephropthy,IgAN(IgA肾病)]牛津分类四项病理指标与临床预后的关系.方法:回顾性分析157例IgA肾病患者的临床、病理资料.根据IgA肾病牛津分类建议的四个病理指标(肾小球系膜细胞增生、肾小球内皮细胞增生、节段性硬化或粘连、...

Study on clinicopathological features and prognosis of 157 cases of IgA nephropathy

Objective To investigate the four pathology variables recommended by IgA nephropathy Oxford classification and its relationship with prognosis of IgAN.Methods Clinical and pathological data of 157 patients(80 males and 77females) with primary IgA nephropathy confirmed by renal biopsy in Guizhou Provincial People’s Hospital from June 2005 to June 2010 were reviewed retrospectively and were correlated with outcomes.Patients were followed for at least 12 month.157 case IgAN patients were divided into two large groups according to the four pathological variables recommended by the IgAN Oxford classification which were the mesangial hypercellularity score,segmental glomerulosclerosis,endocapillary hypercellularity,and tubular atrophy/interstitial fibrosis.One was the Combinations of glomerular features group,include six subgroups which were M0-S0-E0,M0-S1-E0,M1-S0-E0,M1-S0-E0,M0/1-S0-E1,and M0/1-S1-E1.The other weae the combinations of glomerular and tubulointerstitial features group,include six subgroups which were M0-E0-T0,M0-E0-T1-2,M1-E0-T0,M1-E0-T1-2,M0/1-E1-T0,and M0/1-E1-T1-2.All patients received medical examination every six months,which were observed the mean arterial pressure,proteinuria(24 urine protein quantitative),serum urea nitrogen,serum creatinine,and serum cystain C.Results when 157 patients diagnosed by renal biopsy,the association of the score of the four pathology variables recommended by IgA nephropathy Oxford classification and the clinical classification was shown in.The mesangial hypercellularity score was higher than others in these three of clinical classification.MP,ESRD and Cres.The segmental glomerulosclerosis score was higher than others in these three of clinical classification.HT,ESRD and Cres.the tubular atrophy/interstitial fibrosis score was higher than others in these two of clinical classification:ESRD and Cres.There were higher blood urea nitrogen(BUN) and serum creatinine(SCr) significantly in patients with M0-S1-E0,M1-S1-E0,M0/1-S1-E1,than that in patients with others combinations of glomerular features groups.There were higher blood urea nitrogen(BUN),serum creatinine(SCr) and cystain C significantly in patients with M0-E0-T1-2,M1-E0-T1-2,M0/1-E1-T1-2 than that in patients with others combinations of glomerular and tubulointerstitial features groups.Conclusion Four of these pathology variables recommended by IgA nephropathy Oxford classification are independently predictive of clinical outcome which were the mesangial hypercellularity score,segmental glomerulosclerosis,endocapillary hypercellularity,and tubular atrophy/interstitial fibrosis.There are good prognosis in intra-flow tip and poor prognosis in others tip.