2型糖尿病肾病和糖尿病性视网膜病变的相关性研究  

Correlation between type 2 diabetic nephropathy and retinopathy

作　　者：邹古明[1] 张念荣[1] 高红梅[1] 芦建华[1] 卓莉[1] 李文歌[1] 

机构地区：[1]中日友好医院肾内科

出　　处：《临床肾脏病杂志》2015年第4期208-211,共4页Journal Of Clinical Nephrology

基　　金：国家自然科学基金(NO.81170675;NO.81200537)

摘　　要：目的探讨2型糖尿病肾病和糖尿病性视网膜病变的发病机制及其两者之间的相关性。方法选择2004年1月至2014年12月北京中日友好医院肾内科经肾穿刺活检确诊的2型糖尿病。肾病（diabeticnephropathy，DN）患者95例，按照肾脏病理改变程度分为5组，即DN Ⅰ组10例，DN1Ia组12例，DNⅡb组16例，DNⅢ组54例，DNⅣ组3例；将不同组间视网膜病变进行比较，分析视网膜病变与肾脏损伤之间的关系，以及视网膜病变与常用临床指标[24h尿蛋白定量、空腹血糖（fasting blood glucose，FBG）、糖化血红蛋白（glycosylated hemoglobin，HbA1c）、血肌酐（SCr）及肌酐清除率（creatinine clearance rate，Ccr）]之间的关系。结果DN患者肾脏损伤病理分型与视网膜病变呈正相关（r=0．458，P=0．016），但仍有23．2％患者无视网膜病变，分别发生在80．00％的DNⅠ组、33．33％的DNⅡa组、12．50％的DNⅡb组、14．81％的DN Ⅲ组患者中。临床指标中仅24h尿蛋白定量与糖尿病视网膜病变的发生和发展相关。结论尽管糖尿病性视网膜病变常被提示DN，但少部分DN不存在视网膜病变的情况也应被重视。Objective Currently mechanisms of diabetic nephropathy （DIN） and diabetic reti- nopathy（DR）, which are two most common complications of diabetic microvascular disease, remain unclear. In this study, correlation between DN and DR was analyzed. Methods 95 cases with type 2 diabetes in the department of nephrology of China-Japan Friendship Hospital from January, 2004 to December, 2014, which were diagnosed as DN by renal biopsy, were selected and divided into five DiN （ Ⅰ , Ⅱa, Ⅱb, Ⅲ and Ⅳ） groups according to the renal pathologic changes. Retinal changes in different groups（DR0, DR1 and DR2） were compared and correlation of renal pathology with retinal changes were analyzed. Correlations between retinal changes and some clinical indices were also analyzed. Results There was a significant correlation between DN groups（ Ⅰ, Ⅱ a, Ⅱb and Ⅲ ） and different retinal changes（DR0 and DR1）. The rate of patients without DR was 23. 2% in all the 95 patients, 80. 00% in group DN Ⅰ, 33.33 % in group DNⅡ a, 12. 50 % in group DN Ⅱb, and 14. 81% in group DN Ⅲ. Among clinical indices, only 24-hour urinary protein predicted development of DR. Conclusions Though DR is usually considered as a diagnosed marker for most DN patients, a small number of DN patients without DR should be paid attention to the diagnosis of DiN.

关 键 词：糖尿病肾病 糖尿病视网膜病变 肾活检病理诊断 

分 类 号：R587.2[医药卫生—内分泌]