Hill G S, Delahousse M, Nochy D, Tomkiewicz E, Rémy P, Mignon F, Méry J P
Hôpitaux Broussais, St. Louis, Henri Mondor, and Bichat, Paris, France.
Kidney Int. 2000 Sep;58(3):1160-73. doi: 10.1046/j.1523-1755.2000.00272.x.
Various morphologic indices for the evaluation of renal biopsies in lupus nephritis have been developed, of which the most successful have been the NIH Activity Index (AI) and Chronicity Index (CI). We wished to develop a biopsy index from standard light and immunofluorescence (IF) material that would correlate yet more closely with clinical and outcome parameters than the current indices, and be applicable to both treated and untreated cases.
A cohort of 71 patients with lupus nephritis who had initial renal biopsies (Bx1) with systematic second biopsies (Bx2) at six months after induction therapy was studied, with a large number of light microscopic and IF variables evaluated. These were examined statistically to choose the combinations of variables with the highest overall correlations with clinical and outcome parameters.
The adopted biopsy index comprised four elements: Glomerular Activity Index (GAI), a modification of the standard AI with the addition of glomerular monocytes and elimination of interstitial inflammation; Tubulointerstitial Activity Index (TIAI), evaluating several tubular epithelial and inflammatory components, including interstitial inflammation, but excluding tubular atrophy; Chronic Lesions Index, a modification of the standard CI, with the addition of glomerular scars; IF Index (IFI), a semiquantitative index of IF staining for six standard antisera for glomerular capillary, mesangial, tubulointerstitial, and vascular elements. The Biopsy Index showed a statistically higher correlation with clinical and outcome parameters than the NIH AI (P = 0.0170), the NIH CI (P = 0.0009), or their combination (P = 0.0444). At Bx1, comparisons between correlation coefficients for the appropriate AI or CI value and for the Biopsy Index, were: anti-DNA antibodies (0.30 vs. 045), serum creatinine (SCr; 0.33 vs. 0.48), proteinuria (0.22 vs. 0.36), hemoglobin (-0.21 vs. -0.45), and final renal function (0.22 vs. 0.40). Spearman rank correlations showed similar superiority for outcome parameters: doubling of SCr (0.1810 vs. 0.3018) and end-stage renal disease (0.0529 vs. 0.1925). The same improvement of correlations was seen at Bx2 for most parameters, particularly doubling of SCr (0.2716 vs. 0.4753).
The Biopsy Index and/or its components show better correlations with clinical and outcome parameters than the standard AI and CI and other similar indices.
已经开发出多种用于评估狼疮性肾炎肾活检的形态学指标，其中最成功的是美国国立卫生研究院活动指数（AI）和慢性指数（CI）。我们希望从标准光镜和免疫荧光（IF）材料中开发一种活检指数，该指数与临床和预后参数的相关性比当前指数更紧密，并且适用于治疗和未治疗的病例。
研究了一组71例狼疮性肾炎患者，这些患者在诱导治疗后6个月进行了初次肾活检（Bx1）并进行了系统性二次活检（Bx2），评估了大量光镜和IF变量。对这些变量进行统计学检查，以选择与临床和预后参数总体相关性最高的变量组合。
采用的活检指数包括四个要素：肾小球活动指数（GAI），对标准AI进行修改，增加肾小球单核细胞并消除间质炎症；肾小管间质活动指数（TIAI），评估几种肾小管上皮和炎症成分，包括间质炎症，但不包括肾小管萎缩；慢性病变指数，对标准CI进行修改，增加肾小球瘢痕；IF指数（IFI），对肾小球毛细血管、系膜、肾小管间质和血管成分的六种标准抗血清进行IF染色的半定量指数。活检指数与临床和预后参数的相关性在统计学上高于美国国立卫生研究院AI（P = 0.0170）、美国国立卫生研究院CI（P = 0.0009）或它们的组合（P = 0.0444）。在Bx1时，适当的AI或CI值与活检指数的相关系数比较如下：抗DNA抗体（0.30对0.45）、血清肌酐（SCr；0.33对0.48）、蛋白尿（0.22对0.36）、血红蛋白（-0.21对-0.45）和最终肾功能（0.22对0.40）。Spearman等级相关性显示在预后参数方面也有类似优势：SCr翻倍（0.1810对0.3018）和终末期肾病（0.0529对0.1925）。在Bx2时，大多数参数的相关性也有同样的改善，特别是SCr翻倍（0.2716对0.4753）。
活检指数及其组成部分与临床和预后参数的相关性优于标准AI、CI和其他类似指数。
