Tateno S, Kobayashi Y
Nephron. 1987;46(1):28-33. doi: 10.1159/000184291.
Clinical courses of 22 patients with IgA nephropathy, who received serial renal biopsies at a mean interval of 36 +/- 11 months, were observed until 2 years after the second biopsy. Of 22 patients, 12 showed no detectable changes in semiquantitatively analyzed mesangial sclerosis between the serial biopsies. By quantitative analysis, on the other hand, mesangial areas decreased between the serial biopsies in 12 patients (group I), and increased in 10 (group II). At the time of the first biopsy, there were no differences between the two groups in sex, age, creatinine clearance (Ccr), urine protein, hematuria, hypertension, treatment and histological parameters. Although Ccr in group I was stable during the 5-year follow-up, group II showed progressive deterioration of Ccr (p less than 0.005). Histologically, mesangial hypercellularity and crescent formation improved in group I (p less than 0.005 and (p less than 0.05, respectively), and tubular atrophy and interstitial fibrosis progressed in group II (p less than 0.05, each). These results demonstrate that changes in mesangial areas evaluated by quantitative analysis between serial renal biopsies are a valuable prognostic indicator in IgA nephropathy.
对22例IgA肾病患者进行了观察，这些患者接受了系列肾活检，平均间隔时间为36±11个月，观察至第二次活检后2年。22例患者中，12例在系列活检之间经半定量分析显示系膜硬化无明显变化。另一方面，通过定量分析，12例患者（I组）的系列活检之间系膜面积减小，10例患者（II组）的系膜面积增加。首次活检时，两组在性别、年龄、肌酐清除率（Ccr）、尿蛋白、血尿、高血压、治疗及组织学参数方面均无差异。虽然I组的Ccr在5年随访期间保持稳定，但II组的Ccr呈进行性恶化（p<0.005）。组织学上，I组的系膜细胞增多和新月体形成有所改善（分别为p<0.005和p<0.05），II组的肾小管萎缩和间质纤维化进展（各为p<0.05）。这些结果表明，系列肾活检之间通过定量分析评估的系膜面积变化是IgA肾病中一个有价值的预后指标。
