临床指标判定糖尿病肾病诊断与预后价值与局限性

Application of clinical parameters in the diagnosis and prognosis evaluation of diabetic nephropathy:values and limitations

糖尿病肾病是糖尿病主要的并发症,已成为终末期肾脏病的主要病因之一。糖尿病合并肾脏损害有很大比例是非糖尿病性肾脏疾病,两者的治疗和预后明显不同,因此早期诊断对改善预后尤为重要。综合应用年龄、糖尿病病程、糖尿病视网膜病变、血压、血糖等临床指标有助于两者的鉴别诊断及判断预后,但单纯应用临床指标仍存在一定局限性,对怀有疑问的病例仍需依靠肾活检进行确诊。新型生物标志物的临床应用价值还须进一步验证。

Summary：As one of the complications of diabetic mellitus, diabetic nephropathy （DN） has been the main cause of end stage renal disease. It is of great importance to diagnose DN early and accurately as other types of glomerulopathy occurs in- dependently or in parallel with diabetic nephropathy. Previous literatures have reported the role of several clinical factors in diagnosing DN and evaluating the progression of diabetic kidney disease,including age ,diabetes duration, diabetic retinopa- thy, hypertension, higher HbA1 c, et al. But the value of these clinical factors is still controversial and limited. Renal biopsy is required for the final diagnosis of suspicious patients. New biomarkers available need further confirmation in the diagnosis and evaluation of prognosis of diabetic nephropathy.