摘要
目的总结2型糖尿病合并肾损害患者的临床病理特征，筛查有判别意义的临床指标。方法选2011年1月至2015年12月上海交通大学医学院附属瑞金医院接受肾组织活检的2型糖尿病合并肾损害患者，按病理分为糖尿病肾病（DN）组、非糖尿病肾脏疾病（NDRD）组及NDRD合并DN组。收集患者临床、病理资料及实验室数据，对相关因素进行logistic回归分析。结果共入选207例2型糖尿病合并肾损害接受肾活检者，占我科同期肾活检患者的6．82％，其中DN51例，NDRD142例，DN合并NDRD14例。NDRD的肾脏病理表现以膜性肾病占首位（34．5％），其次为IgA肾病（19．7％）。与DN组比，NDRD组糖尿病病程短，Hb水平高，血肌酐水平低，血尿发生率高，高血压及糖尿病视网膜病变发生率低，血糖控制更好，更积极监测血糖及阳性糖尿病家族史少。多因素回归分析显示，阳性糖尿病家族史（OR=4．68，P=0．04）及糖尿病病程长者（OR=1．01，P=0．02）患DN的风险更高。结论NDRD发生率不低。糖尿病病程及糖尿病家族史可作为DN的独立预测因子。
Objective To analyze the clinicopathological characteristics of renal lesions in type 2 diabetic patients and to differentiate diabetic nephropathy （DN） from non-diabetic renal diseases （NDRD）.Methods Type 2 diabetic patients who received renal biopsy in Ruijin Hospital from Janual7 2011 to December 2015 were recruited in this study. Clinical history, laboratory results and pathological data were retrospectively collected. According to the pathological findings, the patients were divided into 3 groups： DN, NDRD, DN ＋ NDRD. Logistic model was applied to explore the independent clinical predictive factors in differentiating DN from NDRD. Results A total of 207 type 2 diabetic patients received renal biopsy, accounting for 6.82% of all biopsy population. Fifty-one patients were diagnosed with DN, 142 with NDRD and 14 with both DN and NDRD. In NDRD, membranous nephropathy（MN） （34.5%） was the most common finding, followed by IgA nephropathy（19.7%）.By contrast, NDRD patients manifested a shorter diabetic course, a higher baseline hemoglobin level, a lower baseline serum creatinine, a higher prevalence of hematuria, a lower prevalence of hypertension and diabetic retinopathy, a better control of blood glucose, better compliance of monitoring blood glucose and less family history of diabetes. In multivariate logistic model, diabetic family history（OR=4.68, P=0.04） and long history of diabetes（OR=l.01, P=0.02） were risk factors of DN. Conclusion There is a high prevalence of NDRD in diabetic patients with renal lesions. Family history of diabetes and duration of diabetes are independent predictors of DN.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2017年第12期924-929,共6页
Chinese Journal of Internal Medicine
基金
十三五国家重点研发计划重大慢性非传染性疾病防控研究（2016YFC1305402）
关键词
糖尿病肾病
非糖尿病肾脏疾病
病理学
临床
Diabetic nephropathy
Non-diabetic renal diseases
Pathology,clinical
