不同病理类型的2型糖尿病肾病患者临床特征比较

Comparison of clinical features in type 2 diabetic patients with various lesions of diabetic nephropathy

目的回顾性分析并比较不同病理类型的2型糖尿病肾病患者的临床特征。方法1990年12月至2004年4月在我院肾脏病研究所住院并行肾穿刺活检的150例2型糖尿病肾病患者,其中弥漫性系膜硬化病变(DIF)患者73例,结节性肾小球硬化病变(NOD)患者77例。分析并比较以下指标:糖尿病病程,高血压病程,体重指数(BMI),眼底病变,HbA_lc,血浆白蛋白,血脂水平,24 h尿蛋白定量,N-乙酰- B-氨基葡萄糖苷酶(NAG),尿渗透压,肌酐清除率。结果(1)NOD组患者糖尿病病程较DIF组患者长[(122.0±8.1 vs56.0±7.8)个月,p<0.01],高血压病程较DIF组患者短[(49.0±10.3 vs 84.0±12.6)个月,p<0.05],BMI较DIF组患者低[(24.1±0.4 vs 26.1±0.4)kg/m^2,P<0.01],尿蛋白水平较DIF组高[(3.8±0.3 vs 1.9±0.2)g/24 h,P<0.01],肌酐清除率较DIF组患者低(45.2±3.1 vs 64.4±3.6) ml/min;(2)NOD组患者中,92%有糖尿病视网膜病变,显著高于DIF组的13%(P<0.01)。结论不同病理类型的糖尿病。肾病患者临床特征不同,NOD组患者的糖尿病病程更长,肾脏损害更明显,更容易出现糖尿病视网膜病变;DIF患者高血压病程更长,BMI更高。

Objective To retrospectively investigate and compare the clinical features in type 2 diabetic patients with various lesions of diabetic nephropathy. Methods One hundred and fifty patients of type 2 diabetes mellitus were registered from December 1990 to April 2004, among them 73 cases of diffuse glomerulosclerosis （DIF） and 77 nodular glomerulosclerosis （NOD） were all proven by renal biopsy. Data such as the durations of diabetes mellitus and hypertension, body mass index （BMI）, diabetic retinopathy, HbAtc, plasma albumin, proteinuria, urine N-acetyl-β-glucosaminidase, urine osmolarity, creatinine clearance rate （Ccr） were collected and compared. Results （ 1 ） Compared with the patients with DIF, the patients with NOD had longer duration of diabetes mellitus [ （ 122.0 ± 8.1 vs 56.0 ± 7.8 ） months, P 〈 0. 01 ） ], shorter duration of hypertention [ （ 49.0 ± 10.3 vs 84.0±12.6）months, P〈0. 05], lower BMI [（24.1 ±0.4 vs 26.1 ±0.4）kg/m^2, P〈0. 01], more severe proteinuria [ （ 3.8 ±0. 3 vs 1.9 ± 0. 2 ） g/24 h, P 〈 0. 01 ], and lower Ccr （45.2 ± 3.1 vs 64.4 ± 3.6 ） ml/ rain. （2） In the patients with NOD and DIF, there were 92% and 13% cases accomparied by diabetic retinopathy respectively （P 〈0.01 ）. Conclusion The patients with NOD had longer diabetic duration, more severe renal damage, and were more likely to develop diabetic retinopathy. The patients with DIF had longer duration of hypertension and higher BMI.