West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
General Hospital of Western Theater Command of the Chinese People's Liberation Army, Chengdu, China.
Int Urol Nephrol. 2022 Jan;54(1):99-109. doi: 10.1007/s11255-021-02861-3. Epub 2021 Apr 27.
Whether the Oxford classification of immunoglobulin A nephropathy can be utilized to predict the adverse renal outcome of Henoch-Schonlein purpura nephritis (HSPN) has been long-debated. We, therefore, performed a meta-analysis to evaluate the prognostic value of Oxford classification lesions in HSPN.
We systematically searched Medline, EMBASE, Web of Science, and the Cochrane Library for articles published from January 1970 to August 2020. Cohort and case-control studies investigating the correlation between the Oxford classification and renal outcome were included, the quality of which was assessed by the Newcastle-Ottawa scale criteria. The pooled odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated with a random-effects model or a fixed-effects model depending on the heterogeneity.
A total of 485 papers were reviewed and eventually 9 comparisons were included, providing data of 1688 patients with HSPN. ORs for adverse renal events were 2.83 (95% CI 1.84-4.35; P < 0.001), 1.96 (95% CI 1.28-2.98; P < 0.05), and 5.45 (95% CI, 3.15-9.45; P < 0.001) for patients with lesions of endocapillary hypercellularity (E), segmental sclerosis (S), and tubular atrophy /interstitial fibrosis (T), respectively, without significant heterogeneity (E: I = 0.0%; P = 0.498; S: I = 22.4%; P = 0.258; T: I = 33.6%; P = 0.171). Subgroup analysis adjusted for age also supported the results that E, S, and T lesions could serve as poor predictors (P < 0.05). Additionally, crescents (C) were strongly associated with renal outcome (OR 2.22; 95% CI 1.62-3.04; P < 0.001), with moderate heterogeneity (I = 49.3%; P = 0.066). However, it should be noted that it is not the presence but the proportions of crescent lesions that were related to the high risk of progression to adverse renal events, because the predictability of lower rates of crescent (C1, with crescents > 0 and ≤ 25%) was uncertain (OR 2.21; 95% CI 0.75-6.51; P > 0.05). Although the pooled OR revealed that lesions of mesangial hypercellularity (M) were correlated with poor renal prognosis (OR 2.41; 95% CI 1.07-5.43; P < 0.05), subgroup analysis separating children from adults indicated that there seemed to be no significant difference.
Oxford classification, especially for E, S, T, and C, might be recommended for patients with HSPN, regardless of children and adults.
关于牛津系膜增生性肾小球肾炎分类是否可用于预测过敏性紫癜性肾炎（HSPN）的不良肾脏结局一直存在争议。因此，我们进行了一项荟萃分析，以评估牛津分类病变在 HSPN 中的预后价值。
我们系统地检索了从 1970 年 1 月至 2020 年 8 月发表的 Medline、EMBASE、Web of Science 和 Cochrane 图书馆中的文章。纳入了研究牛津分类与肾脏结局相关性的队列和病例对照研究，使用纽卡斯尔-渥太华量表标准评估其质量。使用随机效应模型或固定效应模型根据异质性计算合并的比值比（OR）及其 95％置信区间（CI）。
共审查了 485 篇论文，最终纳入了 9 项比较，提供了 1688 例 HSPN 患者的数据。对于存在内皮下细胞增生（E）、节段性硬化（S）和管状萎缩/间质纤维化（T）病变的患者，不良肾脏事件的 OR 分别为 2.83（95％CI 1.84-4.35；P<0.001）、1.96（95％CI 1.28-2.98；P<0.05）和 5.45（95％CI，3.15-9.45；P<0.001），无显著异质性（E：I=0.0％；P=0.498；S：I=22.4％；P=0.258；T：I=33.6％；P=0.171）。调整年龄的亚组分析也支持 E、S 和 T 病变可作为不良预测因素的结果（P<0.05）。此外，新月体（C）与肾脏结局密切相关（OR 2.22；95％CI 1.62-3.04；P<0.001），存在中度异质性（I=49.3％；P=0.066）。然而，应该注意的是，与进展为不良肾脏事件相关的是新月体的存在比例而不是新月体的存在，因为新月体比例较低（C1，新月体>0 且≤25%）的预测性不确定（OR 2.21；95％CI 0.75-6.51；P>0.05）。尽管汇总 OR 显示系膜细胞增生（M）病变与不良肾脏预后相关（OR 2.41；95％CI 1.07-5.43；P<0.05），但将儿童与成人分开的亚组分析表明，两者之间似乎没有显著差异。
牛津分类，特别是 E、S、T 和 C，可能适用于 HSPN 患者，无论儿童还是成人。
