非胰岛素依赖性糖尿病肾病的临床病理分析

CLINICAL AND PATHOLOGICAL INVESTIGATION OF THE RENAL INVOLVEMENT IN NON-INSULIN DEPENDENT DIABETES MELLITUS

目的：了解非胰岛素依赖性糖尿病肾病的临床病理特征。方法：分析解放军肾脏病研究所１９８０～１９９７年经临床和病理证实存在糖尿病肾病的６４例患者，并以６例Ⅰ型糖尿病肾病患者作对照。结果：①Ⅱ型糖尿病肾病确诊与出现蛋白尿的时间无明确规律性；②伴随糖尿病肾病，缺血性心脏病的发生率也很高（５６．３％），２３．４％的患者发生脑卒中；③本组餐后高血糖的发生率１００％，空腹血糖升高者为８２．８％；④与正常对照组及慢性肾炎患者相比，Ⅱ型糖尿病肾病患者Ｂ超检查双肾体积显著增大；⑤本组患者临床症状隐匿，无肉眼血尿，肾病综合征少见，６５％以上患者出现小管受损的实验室检查证据；⑥本组患者肾脏组织学改变以典型的糖尿病肾病为多，占５７．８％（组Ⅲ），轻度病变（组Ⅰ）及弥漫硬化（组Ⅱ）的发生率为１８．８％及２３．４％。三组共同的组织学改变是系膜增生、细胞外基质增加，特征性的Ｋ－Ｗ结节仅见于组Ⅲ，球囊滴与纤维蛋白帽的发生率分别为３３．３％及５１．４％，Ⅱ型患者肾间质血管透明变性明显。结论：Ⅱ型糖尿病肾病患者临床症状隐匿，肉眼血尿及肾病综合征较少，系膜增生、细胞外基质增加是其基本的组织学改变的特点；小管－间质受损的功能性改变较形态学改变出现早?

OBJECTIVE To investigate the clinical and pathological aspects of renal involvement in noninsulin dependant diabetes mellitus(NIDDM).METHODOLOGY A retrospective analysis was made in 64 NIDDM patients who had a renal biopsy between 1980 and 1997.Six cases of IDDM patients with renal involvement who had a renal biopsy were included for the comparison between IDDM and NIDDM.RESULTS The onset of clinical diabetic nephropathy varied in this group of NIDDM patients.The percentage of patients with ischemic heart diseases was 563% and cerebral stroke was 234%.The sizes of the kidneys in this group of patients were found significantly larger than normal control and patients with primary nephritis.The onset of clinical diabetic nephropathy is insidious.Urine analysis revealed no gross hematuria,but a high percentage of patients with decreased osmolarity and increased urine lysozyme and NAGase.Pathological analysis of NIDDM nephropthy revealed that minor change(group Ⅰ)accounted for 188%,diffused sclerosis (group Ⅱ)for 234% and classical change (group Ⅲ)for 578%.Capsular drips was found in 333% and fibronoid cap was found in 514% of patients.KW nodules were found exclusively in groupⅢ,while vascular hylinosis was prominant in groupⅡ.CONCLUSION The onset of renal involvement in NIDDM patients is symptomatic.Tubulointerstitial functional changes are the early abnormality in these patients.The common pathological changes of NIDDM nephropathy include mesangial proliferation,increment of extracellular matrix.Tubulointerstitial lession and hylinoid vascular changes are prominant in NIDDM as compared with those in IDDM.