2型糖尿病肾脏病与2型糖尿病合并非糖尿病肾损害的临床及病理比较

Ciinicopathological comparison of type 2 diabetic kidney disease vs type 2 diabetes mellitus with non-diabetic kidney disease

目的分析比较2型糖尿病。肾脏病与2型糖尿病合并非糖尿病肾损害的临床及病理特征异同点。方法回顾性分析2008年1月至2011年4月在我科住院的患者，临床诊断2型糖尿病、并有蛋白尿，行经皮肾活检穿刺术病理检查共105例患者的临床病理资料。结果（1）非糖尿病肾损害组5I例，占48．57％，一般情况如糖尿病病程、高血压病程、代谢紊乱及肾脏损害均较2型糖尿病肾脏病轻。病理类型以原发性肾小球疾病为主，病理改变包括。肾小球损伤及小管-间质改变较2型糖尿病肾脏病组轻微。（2）2型糖尿病肾脏病患者54例，占51．43％。病理损伤的严重程度与体质量指数、血肌酐、胱抑素C、视黄醇结合蛋白、尿素氮呈正相关，而与血红蛋白、白蛋白和肌酐清除率呈负相关。结论在f临床上，对于病程长、代谢紊乱及临床肾损害指标严重的患者，考虑2型糖尿病肾脏病可能性大。

Objective To investigate the renal clinicopathological features of type 2 diabetes mellitus with or without diabetic renal damage. Methods One hundred and five cases of type 2 diabetes mellitus with proteinuria were enrolled by renal biopsy. The clinical and laboratory data as well as histological characters were analyzed retrospectively from January 2008 to April 2011. According to diabetic renal damage,the patients were divided into two groups. Results （1）Fifty-one cases of type 2 diabetes mellitus with non-diabetic kidney disease （NDKD） accounted for 48.57% in the whole cases of type 2 diabetes mellitus （T2DKD）. Duration of diabetes and hypertension was shorter,and metabolic disorders and kidney damage were milder in NDKD group than T2DKD group significantly. Pathologi- cal types of NDKD group mainly included primary glomerular diseases and pathological changes were obviously milder than T2DKD group. （2）There were 54 patients in T2DKD group, accounting for 51.43%. The severity of the renal damage was positively correlated with body mass index, serum creatinine （SCr）, blood urea nitrogen （BUN）, cystatin C and retinol binding protein （RBP）, but reversely hemoglobin, albumin and clearance of creatinine. Conclusions In clinic, patients with longer duration, metabolic disorders and clinical indicators of serious kidney damage, type 2 diabetic kidney disease is more likely to be diagnosed.