糖尿病肾病病理分型最新国际标准的临床应用(附37例回顾性分析)

New pathologic classification of diabetic nephropathy (retrospective study of 37 cases)

目的：探讨2010年肾脏病理学会研究委员会发布的最新糖尿病肾病（DN）病理分型标准的临床应用。方法：对肾活检伴有微量白蛋白尿（MAU）或临床蛋白尿（CAU）的37例2型糖尿病患者（T2DM）的病理结果重新阅片及分型,观察肾活检组织病理与各病理分型之间的关系,以及分型与间质小管损害之间的关联,分析新标准的临床应用价值。结果：在37例伴MAU或CAU的糖尿病患者中,按既往标准诊断DN 26例,按新标准重新阅片后诊断DN 32例;32例中Ⅰ型DN 1例（3.1%）,Ⅱa型DN 3例（9.4%）,Ⅱb型DN 2例（6.25%）,Ⅲ型DN 23例（71.9%）,Ⅳ型DN 3例（9.4%）,以Ⅲ型DN为主;按肾小管间质评分标准,在新分型后的32例DN中,1~3分的轻型小管间质病变者12例（37.5%）,4~6分中度病变者15例（46.9%）,7分以上病变较重者5例（15.6%）。结论：最新的DN病理分型标准可提高DN的诊断率,并且更加重视肾小管损伤的意义,有利于糖尿病肾病的早期诊断和防治。

Objective： To investigate the new pathological classi cation of diabetic nephropathy （DN） published by Research Committee of the Renal Pathology Society in 2010. Methods： Renal biopsy specimens were obtained from 37 patients with type 2 diabetes mellitus with micro-albuminuria （MAU） or clinical albuminuria （CAU）. These samples were classified according to new pathological classification for DN and new standard scores for interstitial vascular injury. Results： Before the classification, DN was seen in 26 palients. After re-analysis according to the new pathological classification, the patients diagnosed with DN increased to 32. In these 32 DN patients, 1 was classified as type Ⅰ, 3 as type Ⅱa, 2 as type Ⅱb, 23 as type Ⅲ and 3 as type IV; 12 patients had mild interstitial injury, 15 had midrange interstitial injury, while 5 had severe interstitial injury. Conclusion： The new pathological classification of DN can increase the diagnosis rate and attract more attention to tubular and interstitial damage in DN, contributing to the early diagnosis and treatment of DN.