2型糖尿病合并肾损害177例临床病理分析

Clinical and pathological features of type 2 diabetes with nephropathy

目的分析2型糖尿病（T2DM）合并肾损害的临床病理特点,探讨肾穿刺活检在诊断T2DM合并肾损害时的重要性。方法回顾性分析177例T2DM合并肾损害患者的临床资料及肾穿刺活检的病理资料。结果 177例2型糖尿病合并肾损害患者占同期全部肾穿刺活检患者的6.7%（177/2653）,其中女性56例,男性121例。患者年龄24-76岁,平均年龄53.4岁。病理诊断糖尿病肾病（DN）62例,非糖尿病肾病（NDRD）106例,DN合并NDRD 9例。62例DN中,I型DN 2例,IIa型5例,IIb型8例,Ⅲ型41例,Ⅳ型6例。106例NDRD中,Ig A肾病27例,膜性肾病24例,系膜增生性肾小球肾炎21例,高血压肾损伤7例,肾小管间质性炎6例,局灶节段性肾小球硬化症（FSGS）和局灶增生硬化性肾小球肾炎各5例,ANCA相关性血管炎性肾损伤4例,增生硬化性肾小球肾炎3例,淀粉样变性肾病、膜增生性肾小球肾炎、过敏性紫癜性肾炎和新月体性肾小球肾炎各1例。9例DN合并NDRD中,Ⅲ型DN＋Ig A肾病、IIa型DN＋膜性肾病和Ⅲ型DN＋局灶增生性肾小球肾炎各2例,Ⅲ型DN＋系膜增生性肾小球肾炎、Ⅲ型DN＋ANCA相关性血管炎性肾损伤和IIb型DN＋Ⅳ型狼疮性肾炎各1例。结论 T2DM合并肾损害可以是DN也可以是NDRD,还可以是DN合并NDRD,不同的病理类型在临床治疗和预后上有很大的差异。肾穿刺活检可以从组织学上明确诊断,为治疗和判断预后提供依据。

Objective To study the clinical and pathological characteristics of type 2 diabetes mellitus（ T2DM） with nephropathy,and to evaluate the diagnostic importance of the renal biopsy in T2 DM patients. Methods The clinical and pathological data in 177 cases of T2 DM with kidney damage were retrospectively analyzed from October 2010 to May 2014 in our hospital. Results 177 cases of T2 DM with kidney damage accounted for 6. 67%（ 177 /2653） in all the patients with renal biopsy in the same period. Among the 177 cases,56 cases were females and the rest were males. The age of the patients were ranged from 24 to 76 years,with mean of 53. 42 ± 11. 73 years. The pathologic examination showed that 62 cases were diabetic nephropathy（ DN）,106 cases were non-diabetic renal diseases（ NDRD）,and 9 cases were DN merged with NDRD. Of 62 cases of DN,2 cases were type I DN,5 cases were type IIa DN,8 cases were type IIb DN,41 cases were type Ⅲ DN,and 6 cases were type Ⅳ DN. Of 106 cases of NDRD,27 cases were Ig A nephropathy,24 cases were membranous nephropathy,21 cases were mesangial proliferative glomerulonephritis,7 cases were hypertensive renal injury,6 cases were renal tubular interstitial inflammation,5 cases were focal segmental glomerulosclerosis（ FSGS）,5cases were focal hyperplasia of sclerosing glomerulonephritis,4 cases were ANCA associated with vascular inflammatory renal injury,3 cases were hyperplasia of sclerosing glomerulonephritis,1 case was amyloidosis,1 case was membrane proliferative glomerulonephritis,1 case was allergic purpura nephritis,and 1 case was crescent glomerulonephritis. Of 9cases of DN merged with NDRD,2 cases were type Ⅲ DN ＋ Ig A nephropathy,2 cases were type IIa DN ＋ membranous nephropathy,2 cases were type Ⅲ DN ＋ focal proliferative glomerulonephritis,1 case was type Ⅲ DN ＋ mesangial proliferative glomerulonephritis,1 case was type Ⅲ DN ＋ ANCA associated with vascular inflammatory kidney damage,and 1 case was type IIb DN ＋ Ⅳ type lupus nephritis. Conclusion T2 DM with kidney damage can be DN,NDRD,or DN merged with NDRD. Clinical treatment and prognosis of different pathological type of T2 DM with nephropathy are different. The renal biopsy can make a definitive diagnosis and it is of value in guiding clinical treatment and predicting prognosis.