摘要
目的:观察IgA肾病(IgAN)患者重复肾活检与首次肾活检肾组织病变的动态变化,分析其与治疗及疾病预后的关系。方法:观察91例接受重复肾活检的IgAN患者两次肾活检肾组织病变变化,并结合临床和治疗反应进行分析。病理评分采用IgAN牛津分类标准,包括肾小球系膜细胞增生性病变(M)、毛细血管内增生性病变(E)、节段硬化或黏连性病变(S)、肾小管间质病变(T)、肾小球新月体形成(C)、毛细血管袢坏死性病变(N)。根据患者肾组织病理的病变特点分为增生性病变组(伴E、C、N病变)和非增生性病变组;根据两次肾活检临床指标变化分为:病情好转组、病情平稳组和病情进展组。分别从病理和临床两个层面动态地对首次肾活检和重复肾活检肾组织病理变化特点进行分析。结果:(1)增生性病变组患者免疫抑制剂使用率明显高于非增生性病变组(77%vs 23.3%,P<0.01)。经免疫抑制治疗,重复肾活检时患者增生性病变明显改善,肾小球N、E和C病变逆转比例分别达100%、85%和75.6%。但T病变持续进展,肾小球M、S病变无明显变化。(2)病情好转组患者的免疫抑制剂使用率明显高于病情进展组(72.2%vs 39.3%,P<0.01)。重复肾活检时,病情好转组的患者E、N病变消失,C病变明显改善(72.2%vs 16.7%,P<0.01);病情进展组的患者C、N病变无明显变化,但其比例明显高于病情好转组(C:57.1%vs 16.7%,P<0.01;N:25%vs 0,P<0.01)。肾小球M病变比例随临床病情好转而下降,随病情进展呈增加趋势,重复肾活检时病情进展组M病变比例显著高于病情好转者组(46.4%vs 13.9%,P<0.01)。无论患者临床病情好转还是进展,T病变均有加重而S病变则无变化。结论:IgAN患者肾小球增生性病变(E、C、N)经免疫抑制治疗后大多数可逆转或改善,同时伴随临床病情好转。IgAN患者肾组织M和T病变与预后关系密切,S病变与预后无关。上述结果为指导IgAN患者基于肾脏病变特点选择治疗方案提供了有力依据。
Objective： To observe the histological change of IgA nephropathy （IgAN） based on repeat renal biopsy, and analyze its relationship with treatment and prognosis. Methodology：Pathological changes of ninety one IgAN patients with repeat renal biopsies were analyzed by combining with the clinical features and treatment. The scoring was done according to the Oxford classification. Histological features including： mesangial hypercellularity （M）, endocapillary proliferation （ E ）, segmental glomerulosclerosis or adhesion （ S）, tubulointerstitial lesion （ T）, glomerular crescent formation （C） and capillary necrotizing lesion （N）. According to pathological features at first biopsy,the patients were divided intoproliferative group （with E, C or N lesion ） and non-proliferative group. According to changes of clinical features, the patients were divided into improved group, stable group and progress group. The histological changes were detected at the pathological side and the clinical side respectively. Results： （ 1 ） The difference in the usage of immunosuppressant between proliferative group and non-proliferative group was significant （77% vs 23.3%, P 〈 0.01 ）. After immunosuppressive treatment, most proliferative lesions （E, C and N ） were reversed. The E, C and N lesions were significantly reduced at second biopsy （E 85%, C 75.6% , N 100% ）. However, the T lesion kept progressing, and the M and S lesions had no notable change. （2）The difference in the usage of immunosuppressant between improved group and progress group was also significant （72. 2% vs 39.3% ,P 〈0. 01 ）. At second biopsy,the E and N lesions in improved group were disappeared,and most C lesion was improved significantly,while the C and N lesions in progress group were without change. But the difference of the percentage of the C and N lesions between improved group and progress group at second biopsy was notable （C： 57. 1% vs 16. 7% ,P 〈 0. 01, N ：25% vs 0,P 〈 0. 01 ）. The M lesion was ameliorated in improved group,while worsen in progress group. The percentage of M lesion in progress group at the second biopsy was higher than that in improved group （46. 4% vs 13.9% ,P 〈 0.01 ）. No matter the patients were getting better or worse, the T lesion became more serious,and the S lesion had no change. Conclusion ： The proliferative lesions （ E, C and N） of IgAN patients can be reversed mostly after immunosuppressive treatment, accompanied with improved pathogenetic condition. The M and T lesions had a close relationship with the prognosis of IgAN, while the S lesion hadn＇t.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2013年第5期401-408,共8页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
国家自然科学基金重大国际合作基金(81020108016)
国家重点基础研究发展计划(973计划)No.2012CB517600(No.2012CB517606)
关键词
IGA肾病
肾活检
预后
治疗
IgA nephropathy renal biopsy prognosis treatment
