Chen Yinghua, Bao Hao, Liu Zhengzhao, Liu Xia, Gao Erzhi, Zeng Caihong, Zhang Haitao, Liu Zhihong, Hu Weixin
National Clinical Research Centre of Kidney Diseases, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Clin J Am Soc Nephrol. 2017 Mar 7;12(3):417-425. doi: 10.2215/CJN.06200616. Epub 2017 Feb 1.
Our study explored the association of histopathologic classification of ANCA-associated GN with renal survival in Chinese patients with myeloperoxidase-ANCA-associated GN.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Two hundred fifteen patients with biopsy-proven myeloperoxidase-ANCA-associated GN were included from January of 1996 to December of 2014. The biopsies included focal (=27), mixed (=82), crescentic (=47), and sclerotic (=59) classes. The long-term renal outcome and risk factors of myeloperoxidase-ANCA-associated GN for different histopathologic classes were retrospectively analyzed.
During a median follow-up time of 22 (9-51) months, 88 (40.9%) patients reached ESRD. The 5-year renal survival (overall 58.7%) was highest in the focal class (100.0%) and lowest in the sclerotic class (20.7%), with no difference between the mixed (58.9%) and crescentic (67.4%) classes. Patients in the mixed (hazard ratio, 0.34; 95% confidence interval, 0.20 to 0.57; <0.001) and crescentic (hazard ratio, 0.31; 95% confidence interval, 0.16 to 0.59; <0.001) classes were at lower risk for ESRD compared with patients in the sclerotic class, as were patients who received glucocorticoids plus mycophenolate mofetil (hazard ratio, 0.32; 95% confidence interval, 0.18 to 0.60; <0.001) compared with those receiving glucocorticoids alone. In addition, patients with a serum creatinine level ≥4 mg/dl (hazard ratio, 2.93; 95% confidence interval, 1.77 to 4.85; <0.001) or hypoalbuminemia (hazard ratio, 2.11; 95% confidence interval, 1.32 to 3.34; =0.002) were at higher risk for ESRD. A serum creatinine level ≥4 mg/dl and a percentage of global sclerotic glomeruli ≥60% were the two independent risk factors for ESRD in the sclerotic class.
The histopathologic classification of ANCA-associated GN in combination with serum creatinine and serum albumin levels and treatment regimen is associated with renal outcome in myeloperoxidase-ANCA-associated GN. The evaluation of serum creatinine level and percentage of global sclerotic glomeruli provides additional information on the risk of renal survival in the sclerotic class of myeloperoxidase-ANCA-associated GN.
我们的研究探讨了中国抗中性粒细胞胞浆抗体（ANCA）相关肾小球肾炎（GN）患者中，髓过氧化物酶-ANCA相关GN的组织病理学分类与肾脏生存的关系。
设计、地点、参与者及测量指标：纳入1996年1月至2014年12月间215例经活检证实的髓过氧化物酶-ANCA相关GN患者。活检包括局灶性（=27例）、混合性（=82例）、新月体性（=47例）和硬化性（=59例）类别。对不同组织病理学类别的髓过氧化物酶-ANCA相关GN的长期肾脏结局及危险因素进行回顾性分析。
在中位随访时间22（9 - 51）个月期间，88例（40.9%）患者进入终末期肾病（ESRD）阶段。5年肾脏生存率（总体为58.7%）在局灶性类别中最高（100.0%），在硬化性类别中最低（20.7%），混合性（58.9%）和新月体性（67.4%）类别之间无差异。与硬化性类别患者相比，混合性（风险比，0.34；95%置信区间，0.20至0.57；<0.001）和新月体性（风险比，0.31；95%置信区间，0.16至0.59；<0.001）类别患者发生ESRD的风险较低，接受糖皮质激素加霉酚酸酯治疗的患者（风险比，0.32；95%置信区间，0.18至0.60；<0.001）与仅接受糖皮质激素治疗的患者相比也是如此。此外，血清肌酐水平≥4mg/dl（风险比，2.93；95%置信区间，1.77至4.85；<0.001）或低白蛋白血症（风险比，2.11；95%置信区间，1.32至3.34；=0.002）的患者发生ESRD的风险较高。血清肌酐水平≥4mg/dl和全球硬化性肾小球比例≥60%是硬化性类别中ESRD的两个独立危险因素。
ANCA相关GN的组织病理学分类结合血清肌酐、血清白蛋白水平及治疗方案与髓过氧化物酶-ANCA相关GN的肾脏结局相关。血清肌酐水平和全球硬化性肾小球比例的评估为髓过氧化物酶-ANCA相关GN硬化性类别中的肾脏生存风险提供了额外信息。
