2型糖尿病合并肾损伤临床和肾脏病理分析

Clinical and Pathological Analysis of Type 2 Diabetic Patients with Kidney Injury

目的分析2型糖尿病患者合并不同类型肾脏损伤的临床表现、肾脏病理分型,探讨临床特点和病理类型之间的关系,以指导临床诊治。方法分析1998年12月-2008年12月53例接受肾活检的2型糖尿病患者,其中男38例,女15例,平均52岁,糖尿病病程0～22年,平均5年。分析纳入患者的临床表现、肾脏病理特点和肾脏损伤程度。结果 2型糖尿病合并肾脏损伤以中老年多见,年龄50～74岁,其中糖尿病肾病(DN)34例,44.1%的患者肾脏损害出现在发现糖尿病5年后;非糖尿病肾病(DM+NDRD)16例,81.3%的患者肾脏损害出现在发现糖尿病5年内;糖尿病肾病合并非糖尿病肾病(DN+NDRD)3例,平均糖尿病病程均<5年。2型糖尿病合并肾脏损伤的肾脏病理类型多样,除DN(占64.2%)外,17.0%的患者为膜性肾病,7.5%的患者为系膜增生性肾病。结论 2型糖尿病合并肾损伤以DN为多,亦可出现DM+NDRD或DN+NDRD,通过肾活检明确肾脏病理类型对临床治疗及判断预后有指导意义。

Objective To analyze the clinical, pathological characteristics of type 2 diabetic patients with kidney injury, and probe into the relationship between clinical features and pathological type in order to facilitate the diagnosis and treatment. Methods Fifty-three type 2 diabetic patients who received renal biopsy were analyzed from December 1998 to December 2008. There were 38 men and 15 women, average age of 52. The duration of diabetes ranged from 0 to 22 years, average of 5. The clinical and pathological characteristics of the patients and the degree of kidney injury were evaluated. Results Middle and aged people ranged from 50 to 74 years old were prone to suffer from kidney damages. Diabetic nephropathy （DN, n： 34）, of whom about 44. 1% displayed kidney damage 5 years later after diagnosis of diabetes mellitus. About 81.3% of non diabetic renal disease （DM＋NDRD, n= 16） displayed kidney dam- age within 5 years. The average courses of diabetes mellitus of DiN combines with NDRD （DN＋NDRD, n=3） were less than 5 years. The pathological types of diabetes with kidney injury varied from DN （64. 2%） to membrane nephropathy （17. 0%）, mesangial proliferative glomerulonephritis （7. 5%）. Conclusion DN is the commonest pathological pattern in type 2 diabetic patients complicated with kidney injury, DM-kNDRD and DN＋NDRD can also exist. Identification of the pathological patterns of kidney injury by autopsy contributes to guide the treatment and predict the prognosis.