伴与不伴水肿的糖尿病肾病患者的临床与病理特征

Clinical and pathological characteristics of diabetic nephropathy patients accompanied with edema or without

目的探讨伴与不伴水肿的糖尿病肾病（diabetic nephropathy,DN）患者的临床与病理特征。方法将病理诊断明确的170例DN患者分成水肿型DN组（edema DN,E-DN）和非水肿型DN组（nonedema DN,NE-DN）,比较两组患者的临床和病理特征及预后间的差异。结果与基线值比较,E-DN组肾脏病理改变重,糖化血红蛋白（Hb A1c）、血压（BP）、总胆固醇（TC）、24 h尿蛋白定量〉3.5 g的百分比等均显著高于NE-DN组（P〈0.05,P〈0.01）,而e GFR和血浆白蛋白（ALB）、尿比重、尿渗透压等均显著低于NE-DN组（P〈0.05,P〈0.01）。随访2年,E-DN组e GFR下降速率均显著大于NEDN组（P〈0.05）,肾脏终点事件发生率、肾外并发症发病率也显著高于NE-DN组（P〈0.05）。生存分析显示E-DN组预后差（χ^2=17.460,P〈0.01）。危险因素分析发现肾活检时ALB（RR=0.938,P=0.004）、e GFR（RR=0.985,P〈0.01）、肾脏间质病变（RR=1.236,P=0.012）、TC（RR=1.192,P=0.015）、水肿（RR=6.412,P〈0.01）是DN肾脏死亡的独立危险因素。结论伴有水肿的DN患者较不伴有水肿的DN患者血糖控制较差、ALB低、脂质代谢紊乱、肾脏间质病变重、肾脏中位生存时间短,水肿为影响肾脏死亡的独立危险因素。

Objective To investigate the clinical and pathological characteristics of diabetic nephropathy（ DN） patients with edema or not. Methods Totally 170 patients with type 2 diabetic nephropathy,which were diagnosed by renal biopsy,were divided into groups： edema DN（ E-DN） and nonedema DN（ NE-DN） group. The clinical and pathological features and prognosis were compared between the 2 groups. Results Compared with the baseline values,the renal pathological changes were more serious in group E-DN. The integral of the renal interstitial lesions was significantly larger than that of the NE-DN group（ P〈0. 05）. And glycosylated hemoglobin（ Hb A1c）,blood pressure（ BP）,total cholesterol（ TC）,percentage of 24 h urinary protein leakage over 3. 5 g were significantly higher than those in group NE-DN（ P〈0. 05,P〈0. 01）. E-DN group of e GFR and plasma albumin（ ALB） were significantly lower than the NE-DN group. In the 2 years＇ follow-up,E-DN group of patients had e GFR decreased significantly greater than the NE-DN group（ P〈0. 05,P〈0. 01）. The incidence of renal end events was also significantly higher than that of the latter（ P〈0. 05）. Survival analysis showed that the prognosis of group E-DN was poor（ Chi square = 17. 460,P〈0. 01）. Risk factor analysis showed that ALB（ RR = 0. 938,P = 0. 004）,e GFR（ RR =0. 985,P〈0. 01）,interstitial lesion of the kidney（ RR = 1. 236,P = 0. 012）,TC（ RR = 1. 192,P =0. 015）,and edema（ RR = 6. 412,P〈0. 01） were independent risk factors of death in DN kidney.Conclusion When compared with NE-DN group,the E-DN group has a poor blood glucose control,low serum albumin,lipid metabolism disorder,and renal interstitial lesions,and the renal median survival time is short. Edema was an independent risk factor for renal death.