Tubular atrophy/interstitial fibrosis scores of Oxford classification combinded with proteinuria level at biopsy provides earlier risk prediction in lgA nephropathy.
Tubular atrophy/interstitial fibrosis scores of Oxford classification combinded with proteinuria level at biopsy provides earlier risk prediction in lgA nephropathy.
复制标题
牛津分类的肾小管萎缩/间质纤维化评分结合活检时的蛋白尿水平为 lgA 肾病提供早期风险预测
DOI：
10.1038/s41598-017-01223-3
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发表时间：
2017-04-24
影响因子：
4.6
通讯作者：
Liu H
中科院分区：
文献类型：
--
作者：
Zhu X;Li H;Liu Y;You J;Qu Z;Yuan S;Peng Y;Liu F;Liu H
在伊加肾病（IgAN）患者中，MEST与活检时的临床数据相结合对肾脏存活结局的预测作用尚未研究。在入组时测量IgAN牛津分类的MEST和24小时尿蛋白。主要结局是ESRD（eGFR <15 ml/min/1.73 m2）或eGFR永久性降低至活检值的50%以下的复合终点。742例患者入组并随访>3年，并根据活检时的eGFR水平分为两组。多变量逻辑回归显示活检时的蛋白尿（OR 5.307（95%CI 3.003 - 9.376）p = 0.000）、MEST中肾小管萎缩/间质纤维化评分（T）（OR 3.915（95%CI 2.710 - 5.654）p = 0.000）是IgAN患者eGFR下降的两个预测因子。Kaplan-Meier生存曲线显示，T0、T1、T2时各T评分组间肾脏生存结局差异有统计学意义（P < 0.05），T1、T2时各T评分组间肾脏生存结局差异有统计学意义（P < 0.05）。活检时T2合并蛋白尿的患者的肾脏生存结局最差。结论：MEST分级T评分结合活检时蛋白尿可作为IgAN患者肾脏存活结局的重要早期预测指标之一。
The predictive effect of combining MEST with clinical data at biopsy on renal survival outcomes has not been investigated in patients with IgA nephropathy (IgAN). MEST of The Oxford classification of IgAN and 24-hour urine proteinuia measured at enrollment. The primary outcome was a composite of either ESRD (eGFR to <15 ml/min per 1.73 m2), or a permanent reduction in eGFR to below 50% of the value at biopsy. 742 patients were enrolled and follow-up >3 years, and were divided into two groups according to eGFR levels at biopsy. Multivariable logistical regression revealed that proteinuria at biopsy (OR 5.307 (95% Cl 3.003 to 9.376) p = 0.000), tubular atrophy/interstitial fibrosis scores (T) in MEST (OR 3.915 (95%Cl 2.710 to 5.654) p = 0.000) were the two predictors of eGFR decline for IgAN patients. Kaplan–Meier survival curves show significant difference in renal survival outcome among each T scores groups at biopsy (T0, T1, T2) (P < 0.05) and proteinuria levels at biopsy (P < 0.05), individially. Patients with T2 combined proteinuria at biopsy have the worst renal survival outcome. In conclusion, T scores in MEST classification combined with proteinuria at biopsy could be one of the important early predictors for the renal survial outcomes in patients with IgAN.