Sorger K, Gessler M, Hübner F K, Köhler H, Olbing H, Schulz W, Thoenes G H, Thoenes W
Clin Nephrol. 1987 Mar;27(3):111-24.
Quantitative correlative investigations by means of light, immunofluorescence and electron microscopy carried out in the early phase of the disease on 58 patients (children and adults) with acute postinfectious glomerulonephritis (APGN) formed the basis of subtyping APGN into a starry sky type, a mesangial type and a garland type [Sorger et al. 1982 and 1983]. The subtypes also showed differences in the clinical picture. The garland type was of special interest since most patients had severe proteinuria. This caused us to follow-up the patients with these three subtypes (up to 10 years and 7 months). Proteinuria proved to be the most reliable follow-up parameter. A comparison of the three groups showed that proteinuria rapidly declined as a rule in the patients with the starry sky and the mesangial patterns. In the garland pattern there were also cases with a complete disappearance of proteinuria, especially in younger patients, but other patients still had a distinct proteinuria after months to years indicating a protracted or chronic course. The morphological findings of the rebiopsies correlated with the clinical courses, especially with the course of proteinuria. The three morphological subtypes are thus significant for estimating the prognosis of APGN, which is favorable as a rule in patients with the starry sky and mesangial types, but much more unfavorable in patients with the garland type. Even if fewer cases with demonstrated streptococcal etiology were found in the garland pattern group, i.e., among patients with the most uncertain prognosis, than in the remaining groups, these differences were not statistically significant. Therefore, our investigations do not provide any indications that different etiological factors are responsible for the three subtypes. The individual immune response of the host body is likely to be very much more decisive.
在疾病早期，对58例急性感染后肾小球肾炎（APGN）患者（儿童和成人）进行了光镜、免疫荧光和电子显微镜定量相关研究，这些研究为将APGN分为星空型、系膜型和花环型奠定了基础[Sorger等人，1982年和1983年]。这些亚型在临床表现上也存在差异。花环型特别令人关注，因为大多数患者有严重蛋白尿。这促使我们对这三种亚型的患者进行随访（长达10年零7个月）。蛋白尿被证明是最可靠的随访参数。三组比较显示，星空型和系膜型患者的蛋白尿通常会迅速下降。在花环型中，也有蛋白尿完全消失的病例，尤其是年轻患者，但其他患者在数月至数年之后仍有明显蛋白尿，表明病程迁延或呈慢性。重复活检的形态学结果与临床病程相关，尤其是与蛋白尿的病程相关。因此，这三种形态学亚型对于评估APGN的预后具有重要意义，通常星空型和系膜型患者的预后良好，但花环型患者的预后则差得多。即使在花环型组中，即预后最不确定的患者中，发现的链球菌病因病例比其他组少，但这些差异无统计学意义。因此，我们的研究没有提供任何迹象表明不同的病因因素导致了这三种亚型。宿主个体的免疫反应可能起了更为决定性的作用。
