2型糖尿病合并不同类型肾损伤患者的临床和病理特点比较

Clinical and pathological characteristics of type 2 diabetes concomitant with different types of renal injury

目的比较2型糖尿病合并不同类型肾损伤患者的临床和病理特点。方法收集2008年8月至2017年1月在中国医科大学附属盛京医院肾内科接受肾活检并且伴有肾损伤的2型糖尿病患者242例的临床和病理资料。根据病理结果将患者分为非糖尿病肾病(NDN)组(144例)、糖尿病肾病(DN)+NDN组(12例)、DN组(86例)。对3组患者的一般情况和实验室检查资料进行对比分析,对存在组间差异指标进一步进行Logistic回归分析,明确3组患者的临床病理特点。结果 242例患者中NDN组所占比例最高,为59. 5%(144/242)。NDN的病理类型(包括NDN组及DN+NDN组共156例)多种多样,膜性肾病所占比例最大,为48.1%(75/156),其次是免疫球蛋白A肾病,为17. 3%(27/156)。DN组患者年龄小于DND组,血红蛋白和估算肾小球滤过率低于NDN组,而糖尿病病程长于NDN组,收缩压、血肌酐、血清胱抑素C水平高于NDN组,胰岛素治疗的比例以及合并糖尿病视网膜病变比例也高于NDN组,差异均有统计学意义(均P <0. 05)。进一步针对DN和NDN组进行回归分析发现,高龄、糖尿病病程短、未接受胰岛素治疗、贫血程度轻、较高的估算肾小球滤过率支持NDN的诊断(比值比=0. 855、1. 200、0.018、0.965、0.973,均P<0.05)。结论 NDN在合并肾损伤的2型糖尿病患者中并不少见,以膜性肾病最常见。年龄、糖尿病病程、接受胰岛素治疗、血红蛋白、肾小球滤过率对DN及NDN的鉴别具有一定的指导意义。

Objective To analyze the clinical and pathological characteristics of type 2diabetes concomitant with different types of renal injury.Methods Clinical data of 242type 2diabetic patients with renal injury admitted to Shengjing Hospital of China Medical University from August 2008to January 2017were analyzed.According to the pathological results,the patients were divided into non-diabetic nephropathy(NDN)group(n =144),diabetic nephropathy (DN)+NDN group (n =12)and DN group (n =86).General information and laboratory records were analyzed through single factor and Logistic regression analysis.Results Among the 242patients,NDN group accounted for 59.5%(144/242).The pathological types of 156NDN patients were different;membranous nephropathy accounted for 48.1%(75/156);IgA nephropathy accounted for 17.3%(27/156).In the DN group, age,hemoglobin an^t estimated glomerular filtration rate(eGFR)were lower than those in the NDN group;duration of diabetes,systolic blood pressure,serum ereatinine and cystatin C were higher than those in the NDN group; ratios of insulin therapy and diabetic retinopathy were higher than those in the NDN group (all P <0.05).Regression analysis showed that NDN was related to advanced age,short duration of diabetes,non-insulin treatment,mild anemia and high eGFR(odds ratio =0.855,1.200,0.018,0.965,0.973,all P <0.05).Conclusions NDN is common in type 2diabetes with renal injury and membranous nephropatby is the most common pathological type. Age,diabetes course,using insulin,hemoglobin and eGFR may be important indicators of the differential diagnosis between NDN and DN.