Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, PR China.
Clin J Am Soc Nephrol. 2011 Sep;6(9):2175-84. doi: 10.2215/CJN.11521210. Epub 2011 Aug 18.
The Oxford classification of IgA nephropathy (IgAN) may aid in predicting prognosis and providing therapeutic strategy but must be validated in different ancestry.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 410 patients with IgAN, enrolled from one of the largest renal centers in China, were evaluated for the predictive value of the Oxford classification to prognosis defined as end stage renal disease. A total of 294 of these patients were prospectively treated with renin-angiotensin system blockade and immunosuppressants sequentially and were evaluated separately to assess the predictive value to therapeutic efficacy (defined as time-averaged proteinuria <1 g/d). Three pathologists reviewed specimens independently according to the Oxford classification and were blinded to clinical data.
Segmental glomerulosclerosis and tubular atrophy and interstitial fibrosis were independent predictive factors of end stage renal disease. Patients who had >25% of glomeruli with endocapillary hypercellularity showed higher proteinuria, lower estimated GFR, and higher mean BP than patients with less endocapillary hypercellularity. Immunosuppressive therapy showed a protective effect to prognosis of endocapillary hypercellularity in patients with endoncapillary hypercellularity could benefit from immunosuppressive therapy. Mesangial hypercellularity and tubular atrophy and interstitial fibrosis were independent factors of inefficiency of renin-angiotensin system blockade alone. Crescents were not significant in predicting prognosis or in therapeutic efficacy.
The Oxford classification may aid in predicting prognosis and providing a therapeutic strategy in Chinese patients with IgAN.
IgA 肾病（IgAN）的牛津分类法可能有助于预测预后并提供治疗策略，但必须在不同种族中进行验证。
设计、设置、参与者和测量：共评估了来自中国最大的肾脏中心之一的 410 例 IgAN 患者，以评估牛津分类法对定义为终末期肾病的预后的预测价值。其中 294 例患者前瞻性地接受了肾素-血管紧张素系统阻断剂和免疫抑制剂的序贯治疗，并分别进行评估，以评估其对治疗效果（定义为平均蛋白尿 <1 g/d）的预测价值。三名病理学家根据牛津分类法独立评估标本，且对临床数据不知情。
节段性肾小球硬化和肾小管萎缩及间质纤维化是终末期肾病的独立预测因素。有>25%的肾小球伴有毛细血管内细胞增生的患者蛋白尿更高、估算肾小球滤过率更低、平均血压更高。免疫抑制治疗对毛细血管内细胞增生患者的预后有保护作用，而毛细血管内细胞增生患者可能受益于免疫抑制治疗。系膜细胞增生和肾小管萎缩及间质纤维化是肾素-血管紧张素系统阻断剂单独治疗无效的独立因素。新月体在预测预后或治疗效果方面并不重要。
牛津分类法可能有助于预测中国 IgAN 患者的预后，并提供治疗策略。
