【摘要】 【目的】探讨2型糖尿病(T2DM)患者合并肾脏疾病的临床病理特点及预后。【方法】回顾性分析120例尿检异常和(或)Scr升高并接受肾活检的2型糖尿病患者的临床病理资料,并进行了随访。肾脏结局的定义是接受肾脏替代治疗或进入到终末期肾病(ESRD)。Kaplan-Meier分析用于比较肾存活率,Cox比例风险分析用于进行糖尿病肾病(DN)和非糖尿病肾脏疾病(NDRD)进入ESRD的风险比较。【结果】120例2型糖尿病患者中,肾穿刺确诊DN57例,占47.5%;NDRD63例,占52.5%。最常见的NDRD亚类是膜性肾病(MN),其次为IgA肾病(IgAN)。与NDRD组比较,DN组患者中糖尿病病病程较长,肾功能较差,合并糖尿病视网膜病变比例更高。Kaplan-Meier分析显示DN组肾存活率较NDRD组显著降低,DN组1年,5年肾脏生存率仅为81%,41%Vs NDRD组95%,84%,进一步cox比例风险模型校正后显示,与NDRD组患者比较,DN患者进入ESRD的HR=3.81,95%CI1.61～9.01,P=0.002。【结论】糖尿病病程长,肾功能较差,尤其是合并糖尿病视网膜病变有助于DN的临床诊断,但有误诊的风险,对糖尿病合并肾脏疾病的精确诊断需依赖肾活检。与NDRD患者相比,DN患者预后显著较差,区分糖尿病合并肾脏疾病患者的病理类型有重要临床意义。更多还原

【Abstract】 【Objective】To investigate the clinicopathological characteristics and prognosis of T2DM patients with renal involvement.【Methods】We conducted a retrospective analysis of clinical and pathologic data from T2DM patients who received renal biopsy(n = 120),and these patients were followed up. Renal outcome is defined as receiving renal replacement therapy or progression to ESRD.【Results】Among the 120 patients with T2DM,57(47.5%)were diagnosed as DN,and 63(52.5%)as non diabetic renal disease(NDRD). The most common subtype of NDRD is membranous nephropathy. Compared with the NDRD group,the DN group had longer course of diabetes,worse renal function and higher proportion of diabetic retinopathy. Kaplan-Meier analysis showed that the renal survival rate in DN group was significantly lower than that in NDRD group. The 1-year,5-year renal survival rate of DN group was only 81%,41% Vs NDRD group 95,84%. After multivariate adjustment,the risk of ESRD in DN patients was 3.81 times higher than that of NDRD patients(95%CI 1.61-9.01,P=0.002).【Conclusions】There is a risk of misdiagnosis DN by clinical manifestations,and accurate diagnosis depends on renal biopsy. The prognosis of DN patients is significantly worse than NDRD,so it is of great clinical significance to distinguish the pathological types of diabetic patients with kidney disease.更多还原