糖尿病肾病慢性肾脏病4期患者肾脏临床及病理因素与预后的关系  

Clinical and pathological risk factors for renal prognosis in patients with biopsy-proven diabetic nephropathy classified as chronic kidney disease stage 4

作　　者：于天宇 姜世敏 高红梅[1] 邹古明[1] 李文歌[1] Yu Tianyu;Jiang Shimin;Gao Hongmei;Zou Guming;Li Wenge(Department of Nephrology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院肾病科,北京100029

出　　处：《首都医科大学学报》2022年第5期707-712,共6页Journal of Capital Medical University

摘　　要：目的探讨糖尿病肾病(diabetic nephropathy,DN)处于慢性肾脏病(chronic kidney disease,CKD)4期患者肾活体组织检查(以下简称活检)病理分型、临床表现与预后的关系。方法研究对象为2002年1月至2021年3月在中日友好医院肾病科住院行肾活检病理确诊为DN的患者。主要观察终点为进入终末期肾脏病(end stage renal disease,ESRD)或死亡。根据是否发生终点事件将患者分为稳定组和进展组,通过单因素分析及Cox回归分析患者临床表现、病理分型与预后的关系。结果研究共纳入53例DN患者,其中Ⅱb型19例,Ⅲ型32例,Ⅳ型2例。中位随访时间为24(2.0,46.5)个月,中位肾脏生存时间为17.3(8.7,25.8)个月,发生终点事件共33例,其中死亡5例。未继续使用血管紧张素转化酶抑制剂(angiotensin-converting enzyme inhibitors,ACEI)或血管紧张素Ⅱ受体阻滞剂(angiotensinⅡreceptor blockers,ARB)组(n=32)的中位肾脏生存时间为16.5(9.6,23.5)个月,使用ACEI/ARB组(n=21)的中位肾脏生存时间为20.7(8.8,25.8)个月。多因素Cox回归分析结果显示,血脂、空腹血糖、肾小球病理分期对肾脏预后结局的影响均无统计学意义(P>0.05)。结论处于CKD4期DN患者肾活检不同病理分型与预后之间无明显相关性。ACEI/ARB治疗对肾脏生存虽有一定延长但无显著获益,DN患者应及早诊断和治疗。Objective To investigate the pathological types,clinical manifestations and prognosis of patients with pathologically diagnosed diabetic nephropathy(DN)classified as chronic kidney disease(CKD)stage 4.Methods The clinical data of pure DN patients with biopsy-proven diagnosis with CKD stage 4,were selected from the Department of Nephrology of China-Japan Friendship Hospital during January 2002 to March 2021.The primary endpoint was set to the composite of progression to end stage renal disease(ESRD)or death.Patients were divided into the stable and progressive groups according to the occurrence of endpoint events.Univariate analysis and Cox regression were used to analyze the relationship between clinical manifestations,pathological types and prognosis of patients.Results A total of 53 patients were included in the study,including 19 cases of typeⅡb,32 cases of typeⅢ,and 2 cases of typeⅣ.The median follow-up was 24(2.0,46.5)months,and the median renal survival was 17.3(8.7,25.8)months.The primary end point event occurred in 33 patients and 5 of them died.Median renal survival was 16.5(9.6,23.5)months in the non-continued angiotensin-converting enzyme inhibitors(ACEI)/angiotensinⅡreceptor blockers(ARB)group(n=32)and 20.7(8.8,25.8)months in the continued ACEI/ARB group(n=21).The multivariate Cox regression analysis showed that none of triglyceride,control of blood glucose and pathological class were independent prognostic factors for renal survival(P>0.05).Conclusion There was no significant relationship between pathological type and DN renal survival time.The continued use of ACEI/ARB drugs could not effectively delay the progression of advanced CKD in DN.There was no significant correlation between different pathological classification and prognosis of DN during CKD stage 4.ACEI/ARB therapy has a prolonged but no significant benefit for renal survival.Patients with DN should be diagnosed and treated early.

关 键 词：糖尿病肾病 肾活检 慢性肾脏病4期 病理 预后 

分 类 号：R69[医药卫生—泌尿科学]