糖尿病肾病患者肾脏病理改变及其生存预后的相关性研究

Correlation of renal pathological changes with survival and prognosis in patients with diabetic nephropathy

目的研究分析糖尿病肾病(diabetic nephropathy,DN)患者肾脏病理特征及预后,为临床治疗提供依据。方法回顾性分析武汉大学人民医院肾病内科2015年1月至2017年1月住院期间行肾穿刺诊断为DN患者且随访资料完整73例,均给予对症支持治疗,分析73例DN患者肾脏病理分析及预后,评价肾小管间质病变是否可预测DN患者肾脏终点事件的发生。结果根据2010年国际肾脏病理协会推荐的DN肾间质病理改变标准进行分级,73例DN肾小管间质轻度病变组39例,肾小管间质中度病变组20例,肾小管间质重度病变组14例;肾小管间质病变可预测DN患者预后,进一步分析发现血红蛋白及尿素氮可评估肾小管间质病变。结论肾小管间质病变可作为预测DN患者预后的指标,尿素氮及血红蛋白可作为评估肾小管间质损伤临床指标,对DN患者的治疗及预后提供了新的方法。

Objective To study and analyze the renal pathological features and prognosis of diabetic nephropathy,and to provide evidence for clinical treatment.Methods A total of 73 patients with complete follow-up information,diagnosed with diabetic nephropathy by means of renal puncture biopsy during hospitalization in Renmin Hospital of Wuhan University from January 2015 to January 2017 were analyzed retrospectively.All patients received symptomatic supportive treatment.The pathological analysis scores and prognostic effects of 73 patients with diabetic nephropathy were analyzed to evaluate whether tubulointerstitial lesions could predict the occurrence of renal endpoint events in patients with diabetic nephropathy.Results By grading according to the tubulointerstitial pathological criteria recommended by International Society of Renal Pathology in 2010,among 73 cases of DN,39 cases belonged to mild tubulointerstitial pathology group 20 cases to moderate tubulointerstitial pathology group,and 14 cases to severe tubulointerstitial pathology group.Renal tubulointerstitialcould predict the prognosis of DN patients.Further analysis showed that hemoglobin and urea nitrogen could evaluate tubulointerstitial lesions.Conclusions Renal tubulointerstitial lesions can be used as a predictor of prognosis in patients with DN.Urea nitrogen and hemoglobin can be used as clinical marker for evaluating tubulointerstitial injury,providing a new method for the treatment and prognosis of patients with DN.