弥漫硬化型和结节型糖尿病肾病患者临床特征与预后比较

A comparative study of clinical features and prognosis between type-2 diabetic patients with diffusive sclerosis and with nodular nephropathy

目的:回顾性分析并比较弥漫硬化型(DIF)和结节型(NOD)糖尿病肾病患者的临床特征与预后。 方法:1985年 11月至 2004年 4月在我院肾脏病研究所住院并行肾活检,病理符合DIF或NOD的表现且随访的糖尿病肾病患者 124例,男性 85例,女性 39例;DIF58例,NOD66例。分析并比较以下指标:糖尿病病程,高血压病程,体重指数,眼底病变,糖化血红蛋白,血浆白蛋白,血脂水平, 24h尿蛋白定量,NAG酶,尿渗量,肌酐清除率。并比较两组中随访时间超过 1年的 105例患者的人、肾 5年存活率。 结果:①两组患者相比,NOD组患者糖尿病病程较DIF组患者长[ (119 + 8 .5)vs(52 + 8. 9)个月,P<0 .01],尿蛋白水平较DIF组患者高 [ (4. 20 + 3 3)vs(1 .79±2 0)g/24h, P<0. 01],肌酐清除率较DIF组患者低[ (46. 1+ 25. 0vs(68 4+28 .2)ml/min];②NOD组患者中, 90%有糖尿病视网膜病变,DIF组患者中, 14%有糖尿病视网膜病变; χ2 分析表明,两者相比,NOD组更易出现眼底病变(P<0. 01)。③DIF组患者 5年肾存活率和人存活率分别为 80%和 84%;NOD组患者 5年肾存活率和人存活率分别为 31%和 48%,二者差异非常显著(P<0. 01)。NOD组患者人、肾 5年存活率明显小于DIF组患者(P<0. 01)。 结论:DIF和NOD患者的临床特征与预后明显不同,NOD患者糖尿病病程较长,肾?

Objective:In Type 2 diabetic patients, two types of diabetic nephropathy were described pathologically, one with diffusive glomerulosclerosis(DIF), and the other with nodular glomerulosclerosis (NOD). In this study, we retrospectively investigated and compared the clinical features and prognosis between this two subgroups of diabetic nephropathy. Methodology:This study included 124 patients who underwent a evaluation renal biopsy, and 58 were classified in DIF group, and 66 in NOD group. Data as the duration of diabetes and hypertension, body mass index(BMI), diabetic retinopathy, plasma glycosylated hemoglobin, albumin, proteinuria, NAG enzyme, urine osmolity, creatinine clearance rate(Ccr) were retrospectively collected and analyzed. 5 year renal survival rates and patient survival were calculated and compared in those who were followed up for more than 1 year. Results:①Compared to patients in the DIF group, patients in NOD group had longer duration of diabetic mellitus [(119±8 5) vs (52±8 9) m, P <0.01], heavier proteinuria [(4 20±3.3) vs (1 79±2 0) g/24h, P <0 01], lower Ccr [(46 1+ 25 0) vs (68 4+ 28 2) ml/min];②In the NOD group, 90% of patients complicated with diabetic retinopathy, while in the DIF group, only 14% presented with diabetic retinopathy.③In the NOD group, the 5 year renal and patient survival rate were 31% and 48% respectively, while in the DIF group, the 5 year renal and patient survival rate were 80% and 84% respectively ( P <0 01). Conclusion:Diabetic patients with nodular glomerulopathy had longer diabetic duration, more severe renal damage, and poorer prognosis, as compared to those with diffusive glomerulosclerosis. Higher risk to develop diabetic retinopathy was found in diabetic patients with nodular glomerulopathy. We suggested that compared with NOD, DIF maybe the pathological type of an earlier stage in DN.