糖尿病肾病临床与病理分析

Analysis of the pathology and clinic of diabetic nephropathy

目的探讨糖尿病肾病（DN）病理损害程度与临床症状的关系。方法对36例DN患者进行组织学分级（Ⅰ～Ⅳ级），并对其临床症状及实验室结果进行对比研究。结果①24h尿蛋白定量随病理损害程度加重而增加，但Ⅳ级（肾小球硬化〉50％）尿蛋白定量反而减少；②Ⅳ级尿免疫学检测及镜下血尿阳性率明显高于Ⅰ、Ⅱ、Ⅲ级（P〈0．01；P〈0．05）；③DN最常见的临床表现是浮肿和高血压，二者的发生率均随病理损害加重而增加；Ⅳ级较Ⅰ、Ⅱ、Ⅲ级差异明显（P〈0．05）；④DN视网膜病变发生率最高，为86．2％，Ⅱ级以上为100％；⑤心血管病变发生率为57．2％；⑥神经病变、脑血管病变和白内障发生率与病理损害程度无明显相关性。结论DN最常见的临床表现是浮肿及高血压；随着病理损害程度的加重，血尿及免疫学检测异常、血尿阳性率及24h蛋白定量明显增加；视网膜病变与DN关系密切，其次是心血管疾病。

Objective Investigate the relation between the extent of pathological lesions of diabetic nephropathy（DN） and the clinical symptoms of DN. Method Histological classification （1-4 degree） was performed for 36 DN patients and the correlations bemeen clinical symptoms and the pathological results was analyzed. Results ①The quantity of proteinuria in 24 hous was increasing with the aggravation of the extent of rehal damage of DN, hut when developed to degree 4, as the amount of the sclerotic glomerulus greater than 50%, the quantity of urinary protein was decreaseing; ②The patient in degree with higher postive rate of immunohistochemical staining of urine hemituria and microscopic hematurid than other 3 degrecs; ③The most common clinical symptoms of the DN were edema （77%） and hypertension（57. 2%）, the incidence was increashing with the aggravateion of the pathological lesions. There was statistic difference between the positive in patients beyond degree 2 4 and the ther 3 groups （P〈0. 05）; ④The incidence of retinopathy was 86. 2%, there was 100% degree; ⑤The incidence of diabetic cardiovascular disease was 57. 2%; ⑥ For neuropathy, cerebrovascular disease and the incidence of cataract there were no correlation with the extent of pathological changes of DN. Conclusions The common clinical symptoms of the DN are edema and hypertension; the positive rate of staining of urine hemituria and the quantity of proteinuria in 24 hors distinctly increase due to the aggravation of the extent of pathological lesion; There is a close relation between the retinopathy and DN; the cardiovascular diseases also show some relation with the DN.