2型糖尿病合并肾脏损害临床与病理分析

Clinical and pathological analysis of type 2 diabetic patients with nephropathy

目的探讨2型糖尿病(T2DM)合并肾脏损害患者中糖尿病合并非糖尿病性肾脏疾病(NDRD)的发病情况及临床病理特点。方法 T2DM合并肾脏损害患者31例中,NDRD19例,糖尿病肾病(DN)12例,回顾性分析临床及肾组织活检病理资料。结果两组患者在年龄、糖尿病病程、24-h尿蛋白量、肾小球滤过率、高血压等方面未见统计学差异,NDRD组视网膜病变发生率明显低于DN组,肾小球性血尿发生率明显高于DN组,其病理类型以IgA肾病居多。结论 T2DM合并肾脏损害者,若无视网膜病变,或伴肾小球性血尿,则提示NDRD可能性大,应争取肾组织活检,明确诊断。

Objective To investigate clinical and pathological characteristics of non-diabetic renal diseases（NDRD） in type 2 diabetes mellitus（T2DM） patients with renal impairment. Methods Retrospective analysis of clinical information and renal biopsies of thirty-one T2DM patients with renal impairment was carried out, of whom 19 cases were NDRD and 2 cases were diabetic nephropathy （DN）. Results In group NDRD, IgA nephropathy was the most common pathological change. There were no significant differences in age, duration of diabetes mellitus, 24-h proteinuria, hypertension, glomerular filtration rate（GFR）between two groups. The incidence of diabetic retinopathy was lower, while that of glomerular hematuria was higher, in group NDRD than those in group DN. Conclusion The renal impairment of T2DM patients without glomerular hematuria or diabetic retinopathy is with high possibility of NDRD, in which renal biopsy is of importance to clarify the diagnosis.