2型糖尿病患者非糖尿病肾脏疾病临床病理特征分析  

Clinicopathological characteristics of non-diabetic renal disease in patients with type 2 diabetes mellitus

作　　者：方堃[1] 许丹[2] 余晓洋[1] 刘超 魏挺[3] 冯婕[1] FANG Kun;XU Dan;YU Xiaoyang(Department of Nephrology,The First Affiliated Hospital of Xi'an Jiaotong Uiuversity,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院肾内科,710061 [2]西安交通大学生命学院 [3]西安交通大学医院内科

出　　处：《中国糖尿病杂志》2021年第6期416-421,共6页Chinese Journal of Diabetes

基　　金：国家自然科学基金(31770146);陕西省自然科学基金基础研究计划一般面上项目(2018JM7120)。

摘　　要：目的探讨T2DM患者非糖尿病肾脏疾病(NDKD)的临床病理特征,评估肾活检对诊断T2DM患者NDKD的重要性并促进其早期检测。方法回顾性分析390例伴蛋白尿的T2DM并行肾活检患者的病历资料。按照肾活检结果分为单纯DKD组(DKD,n=195)、单纯NDKD组(NDKD,n=170)及DKD合并NDKD组(DKD+NDKD,n=25)。结果390例T2DM患者中,男258例,女132例,年龄(54.65±12.42)岁,DM病程(8.47±6.16)年。肾活检证实的195例(50.0%)DKD患者中,弥漫型糖尿病肾小球硬化症77例(39.5%),结节性糖尿病肾小球硬化症118例(60.5%)。170例(43.6%)NDKD患者中,特发性膜性肾病(IMN)49例(28.8%),IgA肾病38例(22.4%),系膜增生性肾小球肾炎35例(20.6%)DKD合并NDKD 25例(6.41%)。DM病程≥5年患者中,NDKD49例(26.5%);合并DR患者中NDKD 66例(31.4%)。结论T2DM患者NDKD患病率较高,常见IMN,DM病程较长及合并DR无法完全排除NDKD。肾活检可明确诊断DKD、NDKD及NDKD合并DKD,有助于改善肾脏结局。Objective To investigate the clinical and pathological characteristics of non diabetic nephropathy(NDKD)in patients with type 2 diabetes mellitus(T2 DM),and to evaluate the importance of renal biopsy in the diagnosis of NDKD in patients with T2 DM in order to promote the early detection of NDKD in T2 DM.Methods A retrospective analysis of 390 cases of T2 DM patients with proteinuria and renal biopsy were retrospectively analyzed.The medical records were divided into DKD alone,NDKD alone,and DKD combined with NDKD(DKD+NDKD)group according to the kidney biopsy results.Results Among the 390 patients with T2 DM,258 were men and 132 were women.The average age was(54.65±12.42)years old,and the duration of diabetes was(8.47±6.16)years.Renal biopsy confirmed 195 cases(50.0%)of diabetic nephropathy(DKD),in which 77 cases(39.5%)were diffuse diabetic glomerulo sclerosis and 118 cases(60.5%)were nodular diabetic glomerulo sclerosis.170 cases(43.6%)was nondiabetic nephropathy(NDKD),including 49 cases(28.8%)of idiopathic membranous nephropathy(IMN),38 cases(22.4%)of IgA nephropathy,35 cases(20.6%)of mesangial proliferative glomerulo nephritis,25 cases(6.4%)of DKD combined with NDKD.Among patients with DM duration≥5 years,49 cases(26.5%)were NDKD.In patients with T2 DM and DR,66 paients(31.4%)were NDKD.Conclusion The prevalence of NDKD in T2 DM is higher.The most common NDKD is IMN.The existence of longer duration of DM and DR lesions still could not completely rule out NDKD.Kidney biopsy could clearly diagnose DKD,NDKD and NDKD combined with DKD,and help improving renal outcomes.

关 键 词：非糖尿病肾脏疾病 糖尿病肾脏疾病 糖尿病 2型 肾活检 

分 类 号：R587.1[医药卫生—内分泌] R692[医药卫生—内科学]