【作者】 刘潇；

【导师】 孙广东；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2018， 硕士

【摘要】 目的:通过整理2型糖尿病患者合并肾脏疾病的临床、实验室资料,结合肾穿刺活检的结果,回顾性分析这些患者的临床资料特点、临床资料与病理类型的关系、临床指标与肾功能损伤进展的相关性。方法:1、本研究纳入2000年1月至2017年8月间入住于吉林大学第二医院肾病内科的2型糖尿病并经皮质肾穿刺活检证实合并肾脏疾病患者336例,所有入选患者的临床、实验室及病历资料完整,记录患者的性别、年龄、血糖、糖化血红蛋白、血红蛋白、血肌酐、24小时尿蛋白定量等实验室指标,计算肾小球滤过率(eGFR),统计分析糖尿病、肾脏病病史时间长度,应用胰岛素治疗情况,以及糖尿病视网膜病变(DR)、高血压、肾病综合征、肾功能衰竭、贫血发生率;并统计分析合并肾脏疾病的病理类型及各自的比例。2、依据2型糖尿病与肾脏疾病的关系,将入选病人分为三组,其中糖尿病肾病(DN)组81(24.11%)例,非糖尿病肾病(NDRD)组187(55.65%)例,和糖尿病合并非糖尿病肾病(DN+NDRD)组68(20.24%)例。分析比较2型糖尿病合并肾脏疾病患者总体临床和病理资料的关系、各病理分组临床资料之间的关系,探究2型糖尿病合并非糖尿病肾病患者病理分型分期(分级)构成、主要临床综合征病理分型构成,探讨临床及实验室各项资料与肾小球滤过率的相关关系。所有数据应用SPSS 17.0行统计学分析。结果:1、入选病例336例,男211例,女125例,发病年龄在19-82(51.15±11.85)岁,糖尿病病史中位数为3个月,肾脏病史中位数为48.67个月,有73.21%的病例同时临床诊断为高血压,有66.96%接受过胰岛素治疗。DN组、NDRD组和DN+NDRD组在年龄和性别方面无统计学差异,肥胖指数方面DN+NDRD组高于DN组,差异有统计学意义。2、本中心2型糖尿病合并肾脏疾病行肾活检的患者临床及实验室资料分组比较:DN组与NDRD组在糖尿病病史、肾脏病史、血糖、24小时尿蛋白定量、血白蛋白、eGFR、血红蛋白、合并高血压发生率、糖尿病视网膜病变发生率、肾病综合征发生率、贫血发生率方面有统计学差异;DN组与DN+NDRD组在糖尿病病史、肾脏病史、血糖、肾病综合征发生率、贫血发生率方面有统计学差异;NDRD组与DN+NDRD组在糖尿病病史、24小时尿蛋白定量、血白蛋白、eGFR、血红蛋白、合并高血压发生率、糖尿病视网膜病变发生率、肾病综合征发生率、贫血发生率方面有统计学差异。3.在NDRD和DN+NDRD组病理类型分布方面,总体上,以膜性肾病最为多见。NDRD组中以膜性肾病最为多见;DN+NDRD组中以高血压性肾小动脉硬化最为多见。两组在IgA肾病、高血压肾小动脉硬化构成比例方面具有统计学差异。4.膜性肾病分期构成分析,在NDRD组中膜性肾病Ⅰ期最多见,膜性肾病Ⅰ-Ⅱ期次之;在DN+NDRD组中,以膜性肾病Ⅰ期最多见,膜性肾病Ⅱ期次之。5.IgA肾病分级构成分析,在NDRD组中LeeⅢ级最多见,LeeⅡ级次之;在DN+NDRD组中,以LeeⅣ级最多见,LeeⅡ级次之。6.在NDRD组中,临床表现为肾功能衰竭的以硬化性肾小球肾炎、新月体性肾小球肾炎最多见,表现为肾病综合征、高血压、血尿的都以膜性肾病最多见;在DN+NDRD组中,表现为肾病综合征、肾功能衰竭、高血压、血尿的都以高血压性肾小动脉硬化最多见。7.eGFR在DN组中与尿蛋白定量线性相关,在NDRD组中与年龄、收缩压呈线性相关,DN+NDRD组中与年龄、尿蛋白定量呈线性相关。结论:1、本中心2型糖尿病伴肾脏疾病行肾穿刺活检的患者糖尿病病程短,多半不合并糖尿病视网膜病变,大部分合并血尿。2、本中心2型糖尿病伴肾脏疾病行肾穿刺活检的患者有55.65%为NDRD,其中病理类型以膜性肾病最多见;有10.34%为DN+NDRD,其中病理类型以高血压性肾小动脉硬化最常见。3、本中心2型糖尿病伴肾脏疾病行肾穿刺活检的患者中DN组和NDRD组在糖尿病病史、尿蛋白定量、贫血程度、高血压、血尿、糖尿病视网膜病变发生率方面有统计学差异。4、本中心2型糖尿病伴肾脏疾病行肾穿刺活检的患者肾功能进展与年龄、尿蛋白定量、收缩压、糖尿病病史等指标有关。更多还原

【Abstract】 Object:By collating clinical,laboratory and pathological data of diabetic kidney disease,analyzed its clinical characteristics,the relationship between clinical data and pathological classification and the correlation between clinical indicators and impairment of renal function retrospectively.Methods:1.This study collected 336 cases of type 2 diabetes patients with kidney disease confirmed by renal biopsy in nephrology department of second hospital of jilin university from January 2000 to August 2017.The selected subjects had complete clinical,laboratory and pathological data.Made the record of laboratory indexes such as gender,age,blood glucose,glycosylated hemoglobin,hemoglobin,serum creatinine,24 hours urinary protein quantification,calculated the glomerular filtration rate(GFR),made statistics of history of diabetes and kidney disease duration,the incidence of insulin treatment,diabetic retinopathy(DR),hypertension,nephrotic syndrome,renal failure,anemia incidence.And made statistics of the pathological types of renal diseases and their respective proportions.2.According to the pathological diagnosis these cases were divided into three groups which were diabetic nephropathy(DN)of 81 cases(24.11%),DN+NDRD group of,non-diabetic nephropathy(NDRD)of 187 cases(55.65%),non-diabetic and diabetic nephropathy(DN+NDRD)of 68 cases(20.24%).To analyze the relationship between the overall clinical and pathological data of patients with type 2 diabetes mellitus combined with kidney disease and the relationship of the clinical data of each pathological group.To explore the pathological stage(classification)of type 2 diabetes mellitus with non-diabetic nephropathy,the form of the pathological classification of clinical syndromes and the correlation between clinical and laboratory data and glomerular filtration rate.All data were statistically analyzed by using SPSS 17.0.Results:1.There were 336 selected cases,211 males and 125 females.The onset age was between 19 and 82 years old,with an average age of 51.15±11.85 years.The median history of diabetes was 3 months,the median history of kidney disease was 48.67 months,73.21% of the cases were clinically diagnosed as hypertension,and 66.96% of the patients received insulin treatment.There was no statistical difference in age and gender between the groups of DN,NDRD and DN+NDRD,the obesity index in DN+NDRD group was significantly higher than the DN.2.Clinical and laboratory data comparison in groups of T2 DM patients with renal biopsy: There were statistical differences between DN group and NDRD group in the history of diabetes,kidney disease,blood glucose,24 hours urinary protein quantification,eGFR,hemoglobin,blood albumin,incidence of hypertension,DR,nephrotic syndrome,anemia.There were statistical differences between DN group and DN+NDRD group in diabetes history,renal history,blood glucose,nephrotic syndrome incidence and anemia rate.There were statistical differences between DN group and DN+NDRD group in the diabetes history,24 hours urinary protein quantification,eGFR,hemoglobin,blood albumin,incidence of hypertension incidence,DR,nephrotic syndrome,anemia.3.In the pathological type distribution of NDRD and DN+NDRD group,in the mass,membranous nephropathy was the most common.In NDRD group,membranous nephropathy was the most common.In DN+NDRD group,it was hypertensive renal arterial sclerosis.There were statistical differences between the groups of NDRD and DN+NDRD in the distribution of IgA nephropathy and hypertensive renal arterial sclerosis.4.The analysis of stage of membranous nephropathy: In the group of NDRD stage of membranous nephropathy Ⅰ was most common,stage of membranous nephropathy Ⅰ-Ⅱ toke second place(P < 0.05);In the group of DN+NDRD,stage of membranous nephropathyⅠwas most common,stage of membranous nephropathy Ⅱ toke second place.5.The analysis of classification of IgA nephropathy: In the group of NDRD the level of Lee Ⅲ were most common,the level of LeeⅡtoke second place;In the group of DN+NDRD,the level of Lee Ⅳ was most common,the level of Lee Ⅱtoke second place.6.In group of NDRD,the most common pathological type which was manifested asrenal failure were sclerosing glomerulonephritis and crescent glomerulonephritis,the most common pathological type which was manifested as nephrotic syndrome,high blood pressure and hematuria was membranous nephropathy;In the DN+NDRD group,the most common pathological type which was manifested as nephrotic syndrome,renal failure,hypertension,and hematuria was hypertension renal arteriosclerosis.7.In the group of DN the eFFR was linear related with urine protein quantification,in the group of NDRD it was linear related with age,systolic blood pressure and in the group of DN+NDRD it was linear related with age,urine protein.Conclusion:1.Patients of type 2 diabetes mellitus with kidney disease under renal biopsy had short duration of diabetes,most of whom did not combined DR,and most of them combined hematuria.2.55.65% of type 2 diabetes with kidney disease under renal biopsy were NDRD,of which the most common pathological types was membranous nephropathy;with 10.34% of the whole patients were DN+NDRD,of which the most common pathological types was hypertension renal arteriosclerosis.3.Among the patients of type 2 diabetes mellitus with kidney disease under renal biopsy,there were statistical significances between diabetic nephropathy and non-diabetic nephropathy in the indicators of duration of diabetes,urinary protein quantification,the incidence of anemia,hypertension,hematuria,DR.4.Progress in renal function impairment of type 2 diabetes mellitus with kidney disease under renal biopsy were related to indicators of the age,urinary protein quantification,systolic blood pressure,duration of diabetes.更多还原