不同年龄2型糖尿病合并肾脏疾病的病理分析

Pathological analysis of type 2 diabetes mellitus patients of different ages accompanying renal disease

目的分析不同年龄2型糖尿病(T2DM)合并肾脏疾病的病理特征,探索其临床预测价值,明确肾活检的重要性。方法回顾性分析武汉大学人民医院肾内科2008年—2017年行肾活检的178例T2DM患者的病理资料,深入分析比较非老年组(年龄<60岁)135例,年龄17～59岁,平均(45.8±9.8)岁和老年组(≥60岁)43例,年龄60～73岁,平均(64.7±4.1)岁。糖尿病肾病(DN)亚组、非糖尿病肾病(NDRD)亚组和糖尿病肾病合并非糖尿病肾病(DN+NDRD)亚组的肾脏病理特点。结果(1)非老年组DN亚组63例(46.67%),NDRD亚组33例(24.44%),DN+NDRD亚组39例(28.89%);老年组DN亚组17例(39.53%),NDRD亚组13例(30.23%),DN+NDRD亚组13例(30.23%)。(2)非老年组患者合并DN102例(75.56%);老年组合并DN30例(69.76%)。两个年龄组发病率无统计学差异(P>0.05)。(3)非老年组合并NDRD72例(53.33%);老年组合并NDRD26例(60.47%)。两个年龄组发病率无统计学差异(P>0.05)。(4)T2DM患者合并NDRD,遍及所有肾病类型。非老年组患者以IgA肾病(IgAN)(36.11%)为主,老年组患者则以膜性肾病(MN)(42.31%)为主。统计学分析发现,IgAN在两个年龄组患者间无显著性差异(P>0.05),MN则在老年组中发病率高于非老年组,差异有显著性(P<0.05)。(5)狼疮肾炎(LN)、乙肝相关性肾小球肾炎(HBV-GN)、局灶节段性肾小球硬化(FSGS)等较多出现在非老年组。(6)微小病变(MCD)、系膜增生性肾小球肾炎(MPGN)、轻微病变等在两个年龄组发病率无差异(P>0.05)。结论只有肾脏病理学才能确诊不同年龄T2DM患者合并肾脏疾病的类型,指导今后临床实践中要扩大肾活检范围,提高肾活检率,早诊断、早治疗,从而改善患者的预后。

Objective To analyze the pathological features of renal disease in type 2 diabetes mellitus(T2DM)patients of different ages,further to explore their predictive value and to clarify the importance of renal biopsy.Methods T2DM patients who received renal biopsy from 2008 to 2017 were recruited in this study.Pathological data were retrospectively collected.According to the pathological findings,135 patients were fallen into non-elderly group(<60 years old with the age range of 17 to 59 and the average age of 45.8±9.8 years old)and 43 into older age group(≥60 years old with the age range of 60 to 73 and the average age of 64.7±4.1 years old).Three subgroups were created:diabetic nephropathy(DN),non diabetic renal disease(NDRD)and DN+NDRD.Results(1)In non-elderly group,there were 63 patients in DN subgroup(46.67%),33 in NDRD subgroup(24.44%)and 39 in DN+NDRD subgroup(28.89%);In older age group,there were 17 patients in DN subgroup(39.53%),13 in NDRD subgroup(30.23%)and 13 in DN+NDRD subgroup(30.23%).(2)102 patients in non-elderly group were complicated with DN(75.56%),and 30 patients in older age group were complicated with DN(69.76%).No significant difference existed between the two groups(P>0.05).(3)72 patients in non-elderly group were complicated with NDRD(53.33%),and 26 patients in older age group were complicated with NDRD(60.47%).No significant difference existed between the two groups(P>0.05).(4)NDRD was distributed throughout all types of nephropathy.IgA nephropathy(IgAN)(36.11%)was dominated in non-elderly group,and membranous nephropathy(MN)(42.31%)was the most common finding in older age group.No significant difference existed in the occurrence of IgAN between the two groups(P>0.05).The occurrence of MN in older age group was significantly higher than in non-elderly group(P<0.05).(5)Lupus nephritis(LN),hepatitis B virus associated glomerulonephritis(HBV-GN)and focal segmental glomerulosclerosis(FSGS)were more seen in non-elderly group.(6)The incidence of minimal change disease(MCD),mesangial proliferative glomerulonephritis(MPGN),glomerular minor lesion and Henoch-Schonlein purpura nephritis(HSPN)showed no significant difference between the two groups(P>0.05).Conclusions Only renal pathology can diagnose the types of nephropathy in patients with T2DM of different ages,and it is of great value to guide future clinical practice to expand the scope of renal biopsy,improve the rate of renal biopsy,which will improve the prognosis of patients through early diagnosis and early treatment.