507例2型糖尿病合并慢性肾脏病患者肾活检的临床病理特点  

Clinicopathological features in 507 patients with type 2 diabetes mellitus complicated with chronic kidney disease

作　　者：朱凤娟 罗姣[1] 陈晓琼 杨少华 杨芳[1] 贾楠[1] 周秋根[1] 侯凡凡[1] Zhu Fengjuan;Luo Jiao;Chen Xiaoqiong;Yang Shaohua;Yang Fang;Jia Nan;Zhou Qiugen;Hou Fanfan(Department of Nephrology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;First Clinical Medical Institute of Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院肾内科,广州510515 [2]南方医科大学第一临床医学院,广州510515

出　　处：《中华肾脏病杂志》2020年第3期207-213,共7页Chinese Journal of Nephrology

基　　金：国家重点研发计划—重大慢性非传染性疾病防控研究(2018YFC1314000)。

摘　　要：目的 总结和分析糖尿病肾病(diabetic kidney disease,DKD)与非糖尿病肾病(non-diabetic kidney disease,NDKD)患者临床病理特点,为临床2型糖尿病合并慢性肾脏病患者肾活检指征提供循证医学证据.方法 通过南方医科大学南方医院大数据库收集2002年2月至2018年6月在该院接受肾活检的2型糖尿病合并慢性肾脏病患者,并根据肾活检结果将其分为DKD组和NDKD组(包括DKD合并NDKD),比较两组间临床表现及病理类型特点,并采用Logistic回归模型分析DKD和NDKD患者的相关因素.结果 共纳入507例患者,DKD患者114例(22.5%),NDKD患者393例(77.5%).病理表现:NDKD的最常见病理类型为膜性肾病(30.0%)和IgA肾病(19.1%),其中有5.6%患者为DKD合并NDKD.临床表现:与NDKD组患者相比,DKD组患者有更长的糖尿病史(>1年,76.3%比36.1%,P<0.001),更易发生糖尿病视网膜病变(42.1%比4.8%,P< 0.001),24h尿蛋白量更高[3.69(1.70,6.74)g比2.21 (0.91,4.97)g,P<0.001],血肌酐更高[117.5 (85.8,194.5) μmol/L比89.0 (68.0,143.8) μmol/L,P<0.001],血红蛋白更低[(105.07±20.85) g/L比(124.41±25.02) g/L,P=0.002],胆固醇更低[(5.69±1.87) mmol/L比(6.43±2.75) mmol/L,P=0.001].Logistic回归分析显示,糖尿病史(OR=4.162,95%CI 1.717~10.098,P=0.002)、较高收缩压(每增加1 mmHg,OR=1.028,95%CI 1.011~1.045,p=0.001)、降压药服用史(OR=3.141,95%CI 1.496~6.591,P=0.002)、糖尿病视网膜病变(OR=5.561,95%CI2.361~13.100,P<0.001)、较高糖化血红蛋白(每增加1%,OR=1.680,95%CI1.333~2.118,P<0.001)是DKD的相关因素,而血尿(OR=2.781,95%CI 1.334~5.798,P=0.006)和较高血红蛋白(每增加1g/L,OR=1.022,95%CI1.008~1.037,P=0.002)则为NDKD的相关因素.结论 DKD与NDKD之间的临床表现及病理类型存在差异,糖尿病病史、眼底检查、大量蛋白尿、降压药服用史、较高的糖化血红蛋白水平对DKD的诊断有较好的预测作用,而血尿和较高的血红蛋白水平对NDKD的诊断有一定指导意义.糖尿病合并慢性肾脏病患者Objective To analyze the clinicopathological features in diabetic kidney disease(DKD)and non-diabetic kidney disease(NDKD)patients,and provide reference for patients who will receive renal biopsy with diabetes mellitus complicated with chronic kidney disease.Methods The patients with type 2 diabetes mellitus complicated with chronic kidney disease who underwent renal biopsy were collected through the database at the Nanfang Hospital of Southern Medical University from February 2002 to June 2018.According to the results of renal biopsy,they were divided into DKD group and NDKD group(including DKD+NDKD).The clinical manifestations and pathological types were compared between the two groups.Results A total of 507 patients were eventually included in the study.There were 114 cases(22.5%)with DKD and 393 cases(77.5%)with NDKD.Pathologically,the most common pathological types of NDKD were membranous nephropathy(30.0%)and IgA nephropathy(19.1%).Among NDKD patients,5.6%patients had DKD combing with NDKD.In term of the clinical manifestations,DKD patients had a longer history of diabetes(>1 year,76.3%vs 36.1%,P<0.001),higher quantity of urinary protein[3.69(1.70,6.74)g/24 h vs 2.21(0.91,4.97)g/24 h,P<0.001],higher serum creatinine[117.5(85.8,194.5)μmol/L vs 89.0(68.0,143.8)μmol/L,P<0.001]than NDKD patients.But the hemoglobin[(105.07±20.85)g/L vs(124.41±25.02)g/L,P=0.002]and cholesterol[(5.69±1.87)mmol/L vs(6.43±2.75)mmol/L,P=0.001]in DKD patients were lower than those in NDKD patients.Logistic regression analysis showed that diabetes mellitus history(OR=4.162,95%CI 1.717-10.098,P=0.002),higer systolic pressure(every 1 mmHg,OR=1.028,95%CI 1.011-1.045,P=0.001),history of antihypertensive medication(OR=3.141,95%CI 1.496-6.591,P=0.002),diabetic retinopathy(OR=5.561,95%CI 2.361-13.100,P<0.001)and higher glycated hemoglobin level(every 1%,OR=1.680,95%CI 1.333-2.118,P<0.001)were related factors of DKD,while hematuria(OR=2.781,95%CI 1.334-5.798,P=0.006)and higher hemoglobin level(every 1 g/L,OR=1.022,95%CI 1.008-1.037,P=0.0

关 键 词：糖尿病 糖尿病肾病 活组织检查 非糖尿病肾病 临床表现 病理类型 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]