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分類系統可望提升糖尿病腎病變的病人照顧 |  |
2010.06.23 |
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Classification System for Diabetic Nephropathy May Advance Patient Care
分類系統可望提升糖尿病腎病變的病人照顧
莊燕儒譯
腎臟科主任張家築校搞
全球糖尿病患者為兩億八百五十萬人且人數持續攀升。研究者表示，隨著發病率的日益增加將引發更多糖尿病腎病變的個案。不同於其他腎臟疾病，『糖尿病腎病變』無標準的分類系統。
來自16所大學的專家組成一個國際小組著手研究第一型與第二型糖尿病腎病變的分類方法。他們的目標是使用標準化的方式，依臨床預後嚴重度來區分相關病變，以便利世界各地的臨床運用。
研究團隊根據切片結果將糖尿病腎病變分成四階級。它們的範圍分佈從輕微(第一階段)到嚴重(第四階段)。
第一期-腎小球基底膜增厚：切片檢查標本，在光學顯微鏡下呈現輕微且無特異變化。
第二期-體間質擴張，輕微(IIa)或嚴重(IIb)：切片中的所有級別中不符合第三期或第四期的體間質擴張。
第三期-結節性硬化症(又稱作Kimmelstiel-Wilson病變)：至少存在一種顯著的Kimmelstiel-Wilson病灶且不超過一半以上的腎絲球出現全腎絲球硬化。
第四期-嚴重的糖尿病腎絲球硬化-切片檢查中超過 50％的全腎絲球硬化，其損害為糖尿病腎病變造成的結果。
研究人員預測，分類系統將有助於科學家了解糖尿病腎病變的病程發展，藉此改善對於病人的照護。此外他們也指出，今後的研究應會著重於臨床成效的評估。
研究學者寫到：『組織學分類系統是否能預測出臨床結果為很重要的關鍵』。我們認為驗證應該在個別的前瞻性調查中完成，最好包括第一型與第二型糖尿病人的臨床切片且明確定義臨床療效指標。
資料來源J Am Soc Nephrol. Published online February 18， 2010
Classification System for Diabetic Nephropathy May Advance Patient Care
February 18， 2010 — An international group of physicians has designed a categorization system for diabetic nephropathy (DN)， the chief cause of kidney failure， according to an article published online February 18 in the Journal of the American Society of Nephrology.
The number of people with diabetes worldwide is 285 million and rising. The increasing incidence will result in more cases of DN， according to the authors.
"[DN] is a complex condition with varying degrees of severity and varying effects on the kidneys，" write Jan Anthonie Bruijn， MD， PhD， from Leiden University Medical Center， the Netherlands， and colleagues. "Unlike other kidney conditions， [DN] has no standard classification system."
In 2006， experts from 16 universities formed an international team to develop a method for categorizing type 1 and type 2 DNs. Their goal was to differentiate associated lesions by prognostic severity in a standardized manner that could be easily translated into clinical practice around the world.
The physician group separated DN into 4 classes， based on biopsy findings. They range from the least severe (class I) to the most severe (class IV):
The panel tested its DN categorization system in a pilot study. Five pathologists， working independently， assessed 25 biopsies， resulting in identical classifications in 18 cases. The overall outcome of the pilot was "satisfactory，" according to the researchers， with an intraclass correlation coefficient of 0.84.
The classification system will help scientists discover more about the pathways of DN progression， and therefore improve patient care， the authors predict. They note that future research should focus on evaluating clinical results.
"An important question for every histologic classification system is whether it is predictive of clinical outcome，" the authors write. "We feel validation should be done in separate prospective studies， preferably including protocol biopsies of patients with type 1 and type 2 diabetes and clearly defined clinical end points."
The research committee of the nonprofit Renal Pathology Society supported the research. The study authors have disclosed no relevant financial relationships.
J Am Soc Nephrol. Published online February 18， 2010
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