CAJ | 학술논문

目的评估牛津病理分类在儿童原发性IgA肾病中的临床适用性,探讨牛津病理分类系膜增生、毛细血管内增生、节段硬化及肾小管萎缩/间质纤维化4项病理指标与肾活检时临床表现的相关性.方法回顾性分析35例原发性IgA肾病患儿的临床与病理资料,根据牛津病理分类中4项病理指标评分进行分组,分别比较两组间的平均动脉压、肾小球滤过率和蛋白尿水平,以探讨4个病理指标与肾活检时临床指标的相关性.结果牛津分类与肾小球滤过率有负相关关系(相关系数r=-0.48),而与24h尿蛋白定量有正相关关系(相关系数r =0.35).4项病理指标与肾活检时蛋白尿水平均明显相关(均P＜0.05).节段硬化与肾小球滤过率无明显相关(P＞0.05).肾小管萎缩/间质纤维化与肾小球滤过率(P=0.001)、平均动脉压(P=0.03)密切相关.结论牛津病理分类对儿童原发性IgA肾病具有临床适用性,其中的4项病理指标与临床指标相关.
목적 평고우진병리분류재인동원발성IgA신병중적림상괄용성,탐토우진병리분류계막증생、모세혈관내증생、절단경화급신소관위축/간질섬유화4항병리지표여신활검시림상표현적상관성.방법 회고성분석35례원발성IgA신병환인적림상여병리자료,근거우진병리분류중4항병리지표평분진행분조,분별비교량조간적평균동맥압、신소구려과솔화단백뇨수평,이탐토4개병리지표여신활검시림상지표적상관성.결과 우진분류여신소구려과솔유부상관관계(상관계수r=-0.48),이여24h뇨단백정량유정상관관계(상관계수r =0.35).4항병리지표여신활검시단백뇨수평균명현상관(균P＜0.05).절단경화여신소구려과솔무명현상관(P＞0.05).신소관위축/간질섬유화여신소구려과솔(P=0.001)、평균동맥압(P=0.03)밀절상관.결론 우진병리분류대인동원발성IgA신병구유림상괄용성,기중적4항병리지표여림상지표상관.
Objective To assess the validity of the Oxford classification for pediatric patients with primary IgA nephropathy (IgAN) and to analyze the correlations between clinical characteristics at time of biopsy and the Oxford classification,which identified four definitive histological features:mesangial hypereellularity,endocapillary proliferation,segmental sclerosis and tubular atrophy/interstitial fibrosis.Methods Clinical and pathological characteristics of 35 children with primary IgAN were analyzed.The scoring sheet was based on the Oxford classification of IgAN,and four pathological variables,namely mesangial hypercellularity (M),endocapillary proliferation (E),segmental sclerosis (S),and tubular atrophy/interstitial fibrosis (T) were assessed.A total of 35 children with IgAN were grouped according to the scores(M,E,S,T):the M0 and M1 group,E0 and E1 group,S0 and S1 group,T0 and T1/T2 group.These groups were compared in terms of estimated glomeralar filtration rate (eGFR),mean artery pressure (MAP) and proteinuria at time of biopsy.Results We found that the Oxford classification was significantly negatively correlated with eGFR (Pearson's correlation coefficient r =-0.48).However,the Oxford classification was shown to be positively associated with initial proteinuria per day(Pearson's correlation coefficient r =0.35).The M,E,S,T scores were strongly associated with proteinuria at biopsy (P ＜ 0.05),and the lesion S was not correlated with eGFR (P ＞ 0.05).The lesion T was significantly associated with eGFR (P =0.001) and MAP (P =0.03) at biopsy.Conclusion We confirmed that the Oxford classification of IgA nephropathy was valid for children.In addition,our study indicated that the four histological lesions M,E,S and T were significantly associated with clinical features.