2型糖尿病并发慢性肾脏病临床病理特点分析

Analysis of clinicopathological features in type 2 diabetes mellitus complicated with chronic kidney diseases

目的 研究2型糖尿病并发慢性肾脏病（CKD）患者的肾脏损害类型及临床特点.方法 回顾性分析155例伴显性白蛋白尿的2型糖尿病患者的肾脏损害病理类型及临床特点.根据病理表现分为典型糖尿病肾小球病（DG）组、不典型糖尿病相关肾脏病（ADRD）组、非糖尿病肾病组（NDRD）和DG并发NDRD组.结果 DG占18.7%,ADRD占12.9%,NDRD占60.0%,DG并发NDRD占8.4%.DG的糖尿病病程较长,空腹血糖较高,糖尿病视网膜病变（DR）发生率较高,收缩压和平均动脉压较高,尿蛋白量较多,GFR下降更明显.ADRD组年龄较小,体质量指数和肥胖比例较高.NDRD组多可见肉眼血尿和急性肾功能下降,对诊断NDRD有一定预测价值的因素有不伴DR、糖尿病病程小于5年、肉眼血尿、急性肾功能下降、自身免疫性疾病证据和尿蛋白量≥3.5 g/24 h且eGFR≥60 ml/min.结论 2型糖尿病并发CKD的肾脏病理表现多样,NDRD常见,且与ADRD和DG有差异.如2型糖尿病并发慢性肾脏病患者出现以下任何1项：2型糖尿病病程少于5年、不伴DR、肉眼血尿史、急性肾功能下降、尿蛋白量≥3.5 g/24 h但eGFR≥60ml/min、有导致肾损害的系统性疾病证据,应考虑肾活检明确病理诊断.

Objective To study the pathologic pattern and clinical feature of type 2 diabetes mellitus complicated with chronic kidney diseases （CKD）. Methods Clinicopathological features of 155 type 2 diabetic patients complicated with CKD were collected and analyzed retrospectively. The patients were divided into four groups： typical diabetic glomerulopathy （DG）,atypical diabetes-related renal disease （ADRD）, non-diabetic renal diseases （NDRD） and DG complicated with NDRD. Results Renal biopsies revealed DG accounted for 18.7% of the patients, ADRD accounted for 12.9%, NDRD accounted for 60.0%, and DG complicated with NDRD accounted for 8.4%. In DG group, duration of type 2 diabetes was longer;the level of fast blood glucose, systolic blood pressure, mean arterial pressure and prevalence of diabetic retinopathy （DR） were higher;proteinuria was heavier and evaluated glomerular filtration rate （eGFR） was lower. In ADRD group, body mass index and prevalence of obesity were higher;dyslipidemia was more severe. Gross hematuria and acute renal insufficiency could be only found in NDRD group.Without DR, duration of diabetes under 5 years, gross hematuria, acute renal insufficiency,evidences of autoimmune diseases and proteinuria≥3.5 g/24 h but eGFR ≥60 ml/min were specific valuable predictors for NDRD. Conclusions Renal injuries in type 2 diabetic patients are structural heterogeneous, in which NDRD is more common and is different from ADRD and DG.Renal biopsy should be considered when type 2 diabetic patients complicated with CKD present at least one characteristic as follows： duration of diabetes under 5 years, without DR, history of gross hematuria, acute decrease of renal function, evidences of autoimmune diseases and proteinuria ≥ 3.5 g/24 h but eGFR ≥ 60 ml/min