Lee Mi Jung, Kim Seung Jun, Oh Hyung Jung, Ko Kwang Il, Koo Hyang Mo, Kim Chan Ho, Doh Fa Mee, Yoo Tae-Hyun, Kang Shin-Wook, Choi Kyu Hun, Lim Beom Jin, Jeong Hyeon Joo, Han Seung Hyeok
Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
Nephrol Dial Transplant. 2014 Feb;29(2):356-64. doi: 10.1093/ndt/gft398. Epub 2013 Sep 29.
To date, there has been much controversy about the role of crescentic lesion as a significant prognostic factor in immunoglobulin A nephropathy (IgAN). This study evaluated whether crescentic lesions predict adverse renal outcomes in IgAN patients.
A total of 430 patients with biopsy-proven IgAN between January 2000 and December 2009 were included. Histological variables of the Oxford classification (Oxford-MEST) and the presence of crescents were assessed. The primary endpoint was a 50% decline in estimated glomerular filtration rate.
Of the 430 patients, 81 (18.8%) had a crescentic lesion. During a mean follow-up of 61 months, the primary outcome occurred in 19 (23.5%) patients with crescents compared with 40 (11.5%) patients without crescents (P=0.01). A Kaplan-Meier plot showed that the 10-year renal survival rate was significantly lower in patients with crescents than patients without crescents (P=0.01). However, in a multivariable Cox analysis which included clinical factors and the Oxford-MEST, crescents were not significantly associated with an increased risk of developing the primary outcome [hazard ratio: 0.71, 95% confidence interval (CI) 0.36-1.41, P=0.33]. Furthermore, adding crescents to the Oxford-MEST did not improve the discriminative ability for the prediction of renal outcomes [c-statistic: 0.86 (0.81-0.91) vs. 0.86 (0.80-0.91), P=0.21].
Crescentic lesion was not an independent prognostic factor, suggesting that crescents have limited value in predicting renal outcomes of IgAN.
迄今为止，关于新月形病变作为免疫球蛋白A肾病（IgAN）重要预后因素的作用存在诸多争议。本研究评估了新月形病变是否可预测IgAN患者的不良肾脏结局。
纳入2000年1月至2009年12月期间430例经活检证实为IgAN的患者。评估牛津分类法（Oxford-MEST）的组织学变量及新月体的存在情况。主要终点为估计肾小球滤过率下降50%。
430例患者中，81例（18.8%）有新月形病变。在平均61个月的随访期间，19例（23.5%）有新月体的患者出现了主要结局，而无新月体的患者为40例（11.5%）（P=0.01）。Kaplan-Meier曲线显示，有新月体的患者10年肾脏生存率显著低于无新月体的患者（P=0.01）。然而，在一项纳入临床因素和Oxford-MEST的多变量Cox分析中，新月体与发生主要结局风险增加无显著相关性[风险比：0.71，95%置信区间（CI）0.36 - 1.41，P=0.33]。此外，将新月体纳入Oxford-MEST并未提高对肾脏结局预测的判别能力[c统计量：0.86（0.81 - 0.91）对0.86（0.80 - 0.91），P=0.21]。
新月形病变不是独立的预后因素，提示新月体在预测IgAN肾脏结局方面价值有限。
