慢性肾脏病4期糖尿病肾病患者临床病理与预后分析  

Clinical pathological features and prognosis of diabetic nephropathy patients with stage 4 chronic kidney disease

作　　者：于天宇 姜世敏 杨悦[2] 方锦颖 高红梅[2] 邹古明[2] 李文歌[1,2] YU Tian-yu;JIANG Shi-min;YANG Yue;FANG Jin-ying;GAO Hong-mei;ZOU Gu-ming;LI Wen-ge(Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京协和医学院中国医学科学院,北京100730 [2]中日友好医院肾病科,北京100029 [3]北京中医药大学,北京100029

出　　处：《临床肾脏病杂志》2020年第9期717-721,共5页Journal Of Clinical Nephrology

基　　金：国家重点研发计划(2016YFC1305500);中国健康促进基金会(DKD-MBD,2018-2022);北京市自然科学基金(7202179)。

摘　　要：目的研究慢性肾脏病(chronic kidney disease,CKD)4期糖尿病肾病患者(diabetic nephropathy,DN)的临床表现、病理特征与预后的关系。方法研究对象为2005年1月至2019年8月期间在中日友好医院肾病科行肾活检病理确诊为DN,且肾功能处于CKD4期的患者。随访截止时间为发生主要终点事件或随访截止至2019年11月30日。观察主要终点为开始维持性肾脏替代治疗、死亡或估算肾小球滤过率(estimated glomerular filtration rate,eGFR)低于15 mL·min^-1·(1.73m^2)^-1;次要终点为发生心、脑血管事件。以肾活检病理分型为依据,回顾性分析患者的临床资料和病理指标,并进行生存分析。结果本研究共纳入24例患者,其中肾活检病理分型:Ⅱa型3例,Ⅱb型3例,Ⅲ型15例,Ⅳ型3例。中位随访时间20.7(范围5.9~72.4)个月,中位生存期为17.3个月。仍保持CKD4期7例,其中位随访时间14.6(范围5.9~46.8)个月。发生主要终点事件17例,其中位随访时间14.2(范围6.1~72.4)个月。6个月、12个月、18个月的肾脏累积生存率分别为82.6%、59.3%、41.6%。将发生主要终点和未发生主要终点事件的两组进行比较,收缩压和心血管事件差异有统计学意义(P<0.05)。结论CKD4期DN患者,发生复合肾脏事件的中位生存期为17.3个月。血压控制水平及发生心血管事件可能是肾功能进展较快的主要相关因素。Objective To investigate the relationship of clinical manifestations and pathological features with prognosis of diabetic nephropathy(DN)patients with stage 4 chronic kidney disease(CKD).Methods The study subjects were those patients,who were diagnosed as DN by renal biopsy pathology with renal function in stage 4 CKD in Department of Nephrology of Chino-Japan Friendship Hospital from January 2005 to August 2019.The follow-up deadline was either the primary endpoint or until November 30,2019.The primary endpoints of observation were initiation of maintenance kidney replacement therapy,death or estimated glomerular filtration rate(eGFR)less than 15 mL·min^-1·(1.73 m^2)^-1.The secondary endpoints were cardiovascular and cerebrovascular events.Based on the pathological classification of renal biopsy,the clinical and pathological parameters of the patients were respectively analyzed and survival analysis was performed.Results A total of 24 patients were included in the study,3 cases of typeⅡa,with 3 cases of type IIb,15 cases of type III and 3 cases of type IV.The total median follow-up time was 20.7(range 5.9~72.4)months.The total median survival time was 17.3 months.7 patients with stage 4 CKD were still maintained,with the median follow-up time of 14.6(range 5.9~46.8)months;17 patients developed the primary endpoint event,with the median follow-up time of 14.2(range 6.1~72.4)months.The renal cumulative survival rates in 6 months,12 months and 18 months were 82.6%,59.3%and 41.6%,respectively.The comparison between the two groups with and without the primary endpoint events showed that systolic blood pressure and cardiovascular events were statistically different(P<0.05).Conclusions The median survival time of progression to composite kidney endpoint events in DN patients with stage 4 CKD is 17.3 months.Control level of blood pressure and cardiovascular events might be the major relevant factors in progression of renal function.

关 键 词：糖尿病肾病 慢性肾脏病4期 肾活检 病理特征 预后 

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