糖尿病肾病不同程度蛋白尿的相关因素分析及随访

Analysis of factors correlated with proteinuria in diabetic nephropathy and a follow-up

目的分析糖尿病肾病不同程度蛋白尿的临床病理特征及随访资料,探索糖尿病肾病蛋白尿的相关因素及临床意义。方法1993—2003年本科经肾活检诊断为糖尿病肾病的患者,剔除糖尿病肾病合并其它类型肾脏疾病以及诊断不明确者,共60例。按蛋白尿程度分为4组:A组10例.蛋白尿<1.0g/24h;B组16例,蛋白尿≥1.0g/24h且<3.5g/24h;C组20例,蛋白尿≥3.5g/24h且<6g/24h;D组14例,蛋白尿≥6g/24h。对相关因素进行统计分析并记录随访情况。结果多因素回归分析结果显示,糖尿病史(OR=1.015,P=0.038)、收缩压(OR=1.018.P=0.047)、系膜区占肾小球面积比(OR=1.220,P=0.009)、基底膜增厚(OR=3.594,P=0.011)、肾小管萎缩(OR=6.190,P=0.045)、间质病变(OR=1.339,P=0.043)是糖尿病肾病蛋白尿程度的独立相关因素。随访结果显示肾活检时蛋白尿≥3.5g/24h的患者的中位肾存活时间小于蛋白尿<3.5g/24h的患者。C、D组中位肾存活时间为22个月,A、B组为36个月。肾活检时蛋白尿≥3.5g/24h的患者随访1年、2年、3年的肾存活率分别为79.3%、35.7%、17.9%,低于蛋白尿<3.5g/24h的患者的94.4%,83.9%、41.9%。结论糖尿病肾病的蛋白尿与诸多临床指标及病理改变相关,能较好的反映肾小球和肾小管间质病变的程度,并提示肾脏的预后。

Objective To analyze the clinical and pathological characteristics and survival data of diabetic nephropathy (DN) with proteinuria, and find out possible correlated factors for proteinuria in DN. Methods This retropective study included clinical and pathological data of 60 patients with biopsy-proven DN in our department from 1993 to 2003, excluding DN superimposed on NDRD or with ambiguous diagnosis. According to the concentration of proteinuria, the patients were divided into four groups, as group A (proteinuria <1.0 g/24 h, n = 10), group B (1.0 g/24 h ≤ proteinuria<3.5 g/24 h, n=16), group C (3.5g/24 h ≤ proteinuria < 6 g/24 h, n=20), and group D (proteinuria ≥ 6 g/24 h, n = 14). Results Stepwise multivariate regression analysis identified diabetics duration(OR=1 .015 , P=0.038), systolic blood pressure(OR=1.018 , P=0.047), mesangium volume fraction (OR = 1.220, P=0.009) , GBM thickening (OR =3.594, P=0.011 ) , tubular atrophy (OR=6.190, P=0.045) and interstrtial lesions (OR = 1.339 , 0.043) as significant predictors. Follow-up study showed a longer median renal survival (36 months) in group A and B than the counterpart group C and D(22 months). The 1-year, 2-year and 3-year renal survival rates of patients in group A and B (94.4%, 83.9%, 41.9% respectively) were higher than those in group C and D (79.3%, 35.7%, 17.9%, respectively). Conclusion Proteinuria is correlated with many clinical parameters and pathological characteristics in DN and is an effective indicator of glomerulopathy, tubulointerstitial lesions and prognosis.