Olsen S, Bohman S O, Hestbech J, Gundersen H J, Petersen V P, Deguchi N, Maunsbach A B
Acta Pathol Microbiol Immunol Scand A. 1983 Jan;91(1):53-63. doi: 10.1111/j.1699-0463.1983.tb02726.x.
Current classification of glomerulonephritis (GN) is based primarily on light microscopical (LM) histopathological criteria. The aim of the present study was to investigate the occurrence and severity of a number of electron microscopical (EM) lesions in different LM defined classes of GN in order to determine the degree of homogeneity of these classes and the degree of specificity of various EM lesions seen in GN. The analysis was performed using a blind, systematic and semiquantitative method and applied on 91 consecutive biopsies from patients with GN as well as on 11 reference biopsies. Most of the EM lesions were not restricted to a single or a few light microscopically defined classes of GN. EM lesions having direct LM counterparts used as classification criteria were generally present with high scores in the corresponding LM classes but were also present in other types of GN. When the EM-findings were compared with our original classification of the 91 biopsies it was found that about 13% of all biopsies were classified erroneously using only LM. Thus, the groups obtained with the presently used LM classification system are quite heterogenous with respect to ultrastructure and probably with respect to pathogenesis. On the other hand, it appears that many ultrastructural lesions display a more or less continuous spectrum of changes which therefore are difficult to use for classification purposes.
目前肾小球肾炎（GN）的分类主要基于光学显微镜（LM）组织病理学标准。本研究的目的是调查不同LM定义的GN类别中一些电子显微镜（EM）病变的发生情况和严重程度，以确定这些类别的同质程度以及GN中所见各种EM病变的特异程度。分析采用盲法、系统和半定量方法，应用于91例连续的GN患者活检标本以及11例对照活检标本。大多数EM病变并不局限于单一或少数光学显微镜定义的GN类别。用作分类标准的具有直接LM对应物的EM病变通常在相应的LM类别中得分较高，但也存在于其他类型的GN中。当将EM结果与我们对91例活检标本的原始分类进行比较时，发现仅使用LM对所有活检标本进行分类时约有13%被错误分类。因此，目前使用的LM分类系统所得到的组在超微结构方面以及可能在发病机制方面相当异质。另一方面，似乎许多超微结构病变显示出或多或少连续的变化谱，因此难以用于分类目的。
