2型糖尿病肾病与糖尿病视网膜病变异质性的回顾性分析

Retrospective analysis of heterogeneity between type 2 diabetic nephropathy and diabetic retinopathy

目的探讨糖尿病肾病(DN)与糖尿病视网膜病变(DR)的异质性。方法回顾性分析2011年11月至2018年3月在陆军军医大学第二附属医院肾内科和内分泌科首次住院的429例2型糖尿病患者的临床资料,分为DN+DR组120例,DN组96例,DR组54例,DM组159例。观察各组一般资料和实验室指标,分析DN和DR的影响因素。结果与DN组和DR组比较,DN+DR组患者收缩压(SBP)、舒张压(DBP)、尿酸(UA)、胱抑素c(Cys-c)、24 h尿蛋白、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、糖尿病周围神经病变(DPN)患病率升高,肾小球滤过率(eGFR)降低,差异有统计学意义(P<0.05)。与DR组比较,DN组患者DBP、UA、Cys-c、24 h尿蛋白、TC、LDL-C升高,eGFR降低,差异有统计学意义(P<0.05)。与DN组比较,DN+DR组患者在球性硬化比例、重度肾小管损害、重度肾间质损害、毛细血管腔K-W结节、重度间质血管病变方面更为严重(P<0.05)。DN的危险因素与性别、年龄、DR分期、eGFR、TC、三酰甘油(TG)相关(P<0.05),DR的危险因素与病程、DN分级、DPN、DBP、eGFR相关(P<0.05)。结论DN与DR存在发病异质性,DR并不能很好地预测DN的发生。

Objective To study the heterogeneity between diabetic nephropathy(DN)and diabetic retinopathy(DR)by retrospectively analysis.Methods A retrospective analysis was made of 429 patients with type 2 diabetes who were hospitalized for the first time in the department of nephrology and endocrinology,the Second Affiliated Hospital of Army Medical University from November 2011 to March 2018,including 120 patients in the DN+DR group,96 patients in the DN group,54 patients in the DR group,and 159 patients in the DM group.The general data and laboratory indexes of each group were observed,and the influencing factors for DN and DR were analyzed.Results Compared with the DN and DR group,the DN+DR group had higher prevalence of systolic blood pressure(SBP),diastolic blood pressure(DBP),blood uric acid(UA),Cystatin-C(Cys-c),24 h urinary protein,total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and diabetic peripheral neuropathy(DPN)and lower glomerular filtration rate(eGFR),and the difference was statistically significant(P<0.05).Compared with the DR group,the DN group had higher DBP,UA,Cys-c,24 h urinary protein,TC,LDL-C and lower eGFR,and the difference was statistically significant(P<0.05).Compared with the DN group and the DN+DR group,the latter group was more serious in spheric sclerosis ratio,tubule damage,renal interstitial damage,capillary lumen K-W nodules and interstitial vascular lesions(P<0.05).Risk factors for DN were correlated with gender,age,DR stage,eGFR,TC and triglyceride(TG)(P<0.05).The risk factors for DR were correlated with the course of disease,DN grading,DPN,DBP,eGFR(P<0.05).Conclusion There was heterogeneity between DN and DR,but DR could not predict the occurrence of DN.