170例糖尿病肾病肾活检分析  

Renal biopsy analysis of 170 diabetic nephropathy in type 2 diabetes

作　　者：张胜兰[1] 张爱平[2] 邢万佳[1] 郭徽[1] 王艳侠[2] 张秀英[1] 王滨[1] 

机构地区：[1]济南军区总医院内分泌科,济南250031 [2]济南军区总医院肾内科,济南250031

出　　处：《中华糖尿病杂志（1006-6187）》2005年第1期46-48,共3页

摘　　要：目的　探讨肾活检对糖尿病肾病(DN)的诊断价值及治疗的指导作用。　方法　对170例伴有微量白蛋白尿(MAU)或临床蛋白尿(CAU)的 2 型糖尿病患者(T2DM)进行肾穿刺活检,观察肾活检组织病理与各临床参数之间的关系。　结果　在170例伴MAU或CAU的DM患者中,DN 119例(70.0%),其中早期系膜增生者22例,典型DN表现者97例。在典型 DN表现者中,结节性肾小球硬化47例(39.5%),弥漫性肾小球硬化 50 例(42 0%)。DN或 DM合并其他肾脏病变 51例(30 0%),其中DN合并 IgA肾病 13 例(25.5%)、间质性肾炎 8 例(15.7%)、膜增生性肾炎 2 例(3 9%),DM合并 IgA肾病10例(19 6%)、系膜增生性肾小球肾炎4例(7.8%)、微小病变肾炎 4 例(7.8%)、间质性肾炎6例(11.8%)、膜性肾病2例(3.9%)、新月体性肾炎2例(3.9%)。　结论　对临床不能确诊的T2DM蛋白尿患者应提倡做肾活检。Objective To explore the value of renal biopsy in diagnosis and the management of diabetic nephropathy (DN). Methods Renal biopsy specimens were obtained from 170 DN patients with type 2 diabetics. The clinical parameters and histopathological findings of renal biopsy samples were examined. Results DN alone was seen in 119 patients (70.0%), including 22 with early (mesangial) proliferative DN, 97 with typical DN (47 with nodular glomerulosclerosis, 50 with diffused glomerulosclerosis).Non-diabetice renal disease was found in 51 patients. Among those with DN, 13(25.5%)were diagnosed as IgA nephropathy, 8(15.7%) as interstitial nephritis and 2(3.9%) as (proliferative) glomerulonephritis. Among those with DM, 10(19.6%) were diagnosed as IgA (nephropathy), 4(7.8%) as mesangial proliferative glomerulonephritis, 4(7.8%) as minimal change nephritis, 6(11.8%) as interstitial nephritis, 2(3.9%) as membranous nephropathy and 2(3.9%) as crescentic glomerulonephritis. Conclusions It is encouraged that renal biopsy should be done in the T2DM whose DN can not be diagnosed.

关 键 词：DN 肾活检 糖尿病肾病 患者 T2DM IgA肾病 肾小球硬化 临床 肾炎 治疗 

分 类 号：R587.2[医药卫生—内分泌]