To K F, Choi P C, Szeto C C, Li P K, Tang N L, Leung C B, Wang A Y, Ho K K, Wong T Y, Lui S F, Lai F M
Departments of Anatomical and Cellular Pathology, Medicine and Therapeutics, and Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
Am J Kidney Dis. 2000 Mar;35(3):392-400. doi: 10.1016/s0272-6386(00)70191-0.
This prognostic study of primary immunoglobulin A (IgA) nephropathy focused on chronic irreversible glomerular sclerosis and interstitial fibrosis, based on the premise that this disease is characterized by a protracted and, for many, progressive course. We used a chronicity-based histological grading system to assess the biopsy specimens of 126 adults with IgA nephropathy over a median follow-up of 10 years. Our grading system included a glomerular grading (GG) of 1 to 3 based on the extent of glomerular sclerosis, a tubulointerstitial grading (TIG) of 1 to 3 based on the degree of tubular loss or interstitial fibrosis, and the evaluation of hyaline arteriolosclerosis (HA). These three histological parameters were correlated with each other and with serum creatinine level, degree of proteinuria, and blood pressure at the time of renal biopsy. Univariate analysis showed that these three histological and three clinical parameters were significantly correlated with renal survival. By multivariate analysis using the Cox regression model, GG, serum creatinine level, and degree of proteinuria represented independent prognostic factors of renal survival. For a subset of patients at a relatively early stage of disease with a serum creatinine level less than 130 micromol/L at the time of biopsy, all three histological features and degree of proteinuria were significantly correlated with renal survival, and GG was the only independent prognostic factor for renal outcome. This study shows that glomerular sclerosis represents the most important prognostic factor in adult patients with primary IgA nephropathy and has a strong predictive value. Our chronicity-based histological grading system not only correlates well with the natural history of IgA nephropathy but is also reproducible and relatively simple to apply.
这项针对原发性免疫球蛋白A（IgA）肾病的预后研究聚焦于慢性不可逆的肾小球硬化和间质纤维化，其前提是该疾病具有病程漫长且对许多患者而言呈进行性发展的特点。我们使用基于慢性程度的组织学分级系统，对126例成年IgA肾病患者的活检标本进行了评估，中位随访时间为10年。我们的分级系统包括：基于肾小球硬化程度的肾小球分级（GG），范围为1至3级；基于肾小管丢失或间质纤维化程度的肾小管间质分级（TIG），范围为1至3级；以及对透明样小动脉硬化（HA）的评估。这三个组织学参数相互关联，且与肾活检时的血清肌酐水平、蛋白尿程度和血压相关。单因素分析显示，这三个组织学参数和三个临床参数与肾脏生存率显著相关。通过使用Cox回归模型进行多因素分析，GG、血清肌酐水平和蛋白尿程度是肾脏生存的独立预后因素。对于疾病相对早期、活检时血清肌酐水平低于130微摩尔/升的一部分患者，所有三个组织学特征和蛋白尿程度均与肾脏生存率显著相关，且GG是肾脏预后的唯一独立预后因素。本研究表明，肾小球硬化是成年原发性IgA肾病患者最重要的预后因素，具有很强的预测价值。我们基于慢性程度的组织学分级系统不仅与IgA肾病的自然病程密切相关，而且具有可重复性且应用相对简单。
