Class IV-S versus class IV-G lupus nephritis:: Clinical and morphologic differences suggesting different pathogenesis
Class IV-S versus class IV-G lupus nephritis:: Clinical and morphologic differences suggesting different pathogenesis
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DOI：
10.1111/j.1523-1755.2005.00688.x
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发表时间：
2005-11-01
影响因子：
19.6
通讯作者：
Bariéty, J
中科院分区：
文献类型：
--
作者：
Hill, GS;Delahousse, M;Bariéty, J
背景资料。最近提出的狼疮性肾炎的新分类将IV(弥漫性增生性)狼疮性肾炎分为以节段性增生性病变为主的病例(IV-S)和以全局性增殖性病变为主的病例(IV-G)。这份报告探讨了这种区别的有效性以及两种类型的皮损在发病机制上的可能差异。以前报道的一系列严重狼疮性肾炎的患者，在诱导治疗后6个月进行了初始活检(Bx1)和对照活检(Bx2)，根据新提出的分类进行了重新分类。从最初的65例患者中，15例患者被重新分类为IV-S类皮损，31例患者为IV-G类皮损。所有入选患者的活组织检查和随访的临床数据均可获得。IV-G病变的患者与IV-S患者相比，蛋白尿更严重，血清Hb更低，CH50更低，Scr更高(P=0.06)，C3s更低(P=0.08)。血清CH50、C3水平与IV-G级病变严重程度呈负相关，与IV-S级病变程度无关。在光镜下，IV-G级病变的患者在IF上有更多的整体免疫沉积和内皮下沉积，并有更多的透明沉积。相比之下，IV-S组主要表现为系膜沉积和肾小球纤维蛋白样坏死率(13.3+/-15.3%对5.6+/-8.0%，P=0.03)。其他区别包括仅在IV-G级病变中发现膜增生性特征，并且该组肾小球单核/巨噬细胞比IV-S级病变更常见(1.77+/-0.92vs.0.86+/-0.77，P=0.008)。最后，IV-G类病变经常累及所有存活的肾小球(74.2%)，而节段性增生性病变从未累及(P
Background. A recently proposed reclassification of lupus nephritis divides class IV (diffuse proliferative) lupus nephritis into those cases with predominantly segmental proliferative lesions (class IV-S) and those with predominantly global proliferative lesions (class IV-G). This report explores the validity of this distinction and possible differences in pathogenesis between the 2 types of lesions.Methods. Patients from a previously reported series of severe lupus nephritis, with initial biopsies (Bx1) and control biopsies (Bx2) at 6 months after induction therapy were reclassified according to the newly proposed classification. From the original series of 65 patients, 15 patients were reclassified as having class IV-S lesions and 31 patients class IV-G lesions. Clinical data at both biopsies and follow-up were available on all patients selected.Results. Patients with IV-G lesions had worse proteinuria, lower serum hemoglobins, lower CH50s, and likely higher SCrs (P= .06) and lower C3s (P= .08) than class IV-S patients. Serum CH50 and C3 correlated negatively with severity of class IV-G lesions, but not at all with class IV-S lesions. Patients with class IV-G lesions had greater overall immune deposits and subendothelial deposits on IF and greater hyaline deposits on light microscopy. By contrast, class IV-S showed predominant mesangial deposits and a much higher rate of glomerular fibrinoid necroses (13.3 +/- 15.3% vs. 5.6 +/- 8.0% of viable glomeruli, P= .03). Other distinctions included the fact that membranoproliferative features were found only in class IV-G lesions, and glomerular monocyte/macrophages were much more frequent in this group than in class IV-S lesions (1.77 +/- 0.92 vs. 0.86 +/- 0.77, P= .008). Finally, class IV-G frequently involved all viable glomeruli (74.2% of cases), whereas segmental proliferative lesions never did (P