Lee Hyun Soon, Lee Myung Suk, Lee Sa Min, Lee Sang Yun, Lee Eun Sun, Lee Eun Young, Park So Yeon, Han Jin Suk, Kim Sungkwon, Lee Jung Sang
Department of Pathology, Seoul National University College of Medicine, Chongno-gu, Yongon-dong 28, Seoul 110-799, Korea.
Nephrol Dial Transplant. 2005 Feb;20(2):342-8. doi: 10.1093/ndt/gfh633. Epub 2004 Dec 23.
The glomerular grading system is useful to compare biopsy specimens and to predict the natural course of disease in IgA nephropathy (IgAN), although no grading system can be perfect.
H. S. Lee's grading system for IgAN was refined as follows: grade I, normal or focal mesangial cell proliferation; grade II, diffuse mesangial cell proliferation, or <25% of glomeruli with crescent (Cr)/segmental sclerosis (SS)/global sclerosis (GS); grade III, 25-49% of glomeruli with Cr/SS/GS; grade IV, 50-75% of glomeruli with Cr/SS/GS; grade V, >75% of glomeruli with Cr/SS/GS. This refined H. S. Lee grading system was then tested for clinical relevance on 187 patients with IgAN followed up for an average of 6.5 years (minimum, 3 years). In the survival analysis, a modified primary end-point (progressive renal disease) was used.
The glomerular grades were significantly related to hypertension, serum creatinine levels and the amounts of proteinuria at time of biopsy. By univariate analysis, glomerular grades, hypertension, renal insufficiency and significant proteinuria (> or =1 g/day) were significantly associated with progressive renal disease. By multivariate analysis using the Cox regression model, glomerular grades, renal insufficiency and significant proteinuria were independent prognostic factors for progressive renal disease. At the end of follow-up, glomerular grades were significantly related to serum creatinine levels, amounts of proteinuria, hypertension and progressive renal disease.
These findings indicate that the refined H. S. Lee grading system for IgAN is useful in assessing the patients' clinical outcome and is sufficiently simple and easy to reproduce as to be universally applicable in prognostic work.
肾小球分级系统有助于比较活检标本，并预测IgA肾病（IgAN）的疾病自然进程，尽管没有一种分级系统是完美的。
对H. S. Lee的IgAN分级系统进行了如下改进：I级，正常或局灶性系膜细胞增生；II级，弥漫性系膜细胞增生，或<25%的肾小球有新月体（Cr）/节段性硬化（SS）/球性硬化（GS）；III级，25%-49%的肾小球有Cr/SS/GS；IV级，50%-75%的肾小球有Cr/SS/GS；V级，>75%的肾小球有Cr/SS/GS。然后，在187例平均随访6.5年（最短3年）的IgAN患者中，对这种改进后的H. S. Lee分级系统的临床相关性进行了测试。在生存分析中，使用了改良的主要终点（进行性肾病）。
肾小球分级与活检时的高血压、血清肌酐水平和蛋白尿程度显著相关。单因素分析显示，肾小球分级、高血压、肾功能不全和大量蛋白尿（≥1 g/天）与进行性肾病显著相关。使用Cox回归模型进行多因素分析时，肾小球分级、肾功能不全和大量蛋白尿是进行性肾病的独立预后因素。随访结束时，肾小球分级与血清肌酐水平、蛋白尿程度、高血压和进行性肾病显著相关。
这些发现表明，改进后的IgAN的H. S. Lee分级系统有助于评估患者的临床结局，且足够简单易重复，可普遍应用于预后评估工作。
