2型糖尿病肾病合并非糖尿病肾病的临床病理特征及预后研究

Pathological features and prognosis of type 2 diabetic kidney disease complicated with non-diabetic kidney disease

目的探讨2型糖尿病(T2DM)糖尿病肾病(DKD)合并非糖尿病肾病(NDKD)患者的临床病理特征和预后及其影响因素。方法回顾性纳入2014年1月至2018年6月于郑州大学第一附属医院行肾活检确诊为T2DM DKD的患者共363例,按照病理结果分为DKD合并NDKD(MIX组,n=142)及单纯DKD(DKD组,n=221)。记录基线资料(糖尿病病程、视网膜病变病史等),并检测空腹血糖、糖化血红蛋白、血肌酐等生化指标。计算预估肾小球滤过率(eGFR)。终点事件定义为进展至终末期肾病、eGFR较基线下降40%或死亡。建立logistic回归模型分析T2DM DKD患者合并NDKD的相关因素,用Kaplan-Meier法分析各组肾脏预后并采用Cox回归分析探究影响MIX组预后的危险因素。结果 363例患者肾活检时平均年龄(50.0±9.9)岁,其中男性233例(64.2%)。MIX组与DKD组性别、年龄差异无统计学意义(均P>0.05)。多因素logistic回归分析显示,糖尿病病程≤5年[比值比(OR)2.136,95%可信区间(CI):1.315~3.471,P<0.01]、eGFR较高(OR:1.999,95%CI:1.246~3.209,P<0.01)及不合并贫血(OR:2.596,95%CI:1.614~4.175,P<0.01)与T2DM DKD患者合并NDKD独立相关。采用1∶1配对病例对照研究筛选出与MIX组性别、基线年龄、糖尿病病程、肾功能一致的DKD组作为对照,Kaplan-Meier生存分析显示,两组预后差异无统计学意义(Log-rankχ2=1.138,P=0.286),且合并视网膜病变[风险比(HR):2.162,95%CI:1.056~4.428,P=0.035]及尿蛋白定量≥3.5 g/24 h(HR:2.387,95%CI:1.018~5.552,P=0.045)是MIX组预后较差的独立危险因素。结论 T2DM DKD患者糖尿病病程较短、eGFR较高、不合并贫血提示更可能合并NDKD。

Objective To explore clinical,pathological and prognostic characteristics of patients with type 2 diabetic kidney disease and non-diabetic kidney disease and its influence factors.Methods A total of 363 patients with type 2 diabetic kidney disease confirmed by renal biopsy in the First Affiliated Hospital of Zhengzhou University between January 2014 and June 2016 were retrospectively included in this study.All patients were divided into diabetic kidney disease combined with non-diabetic kidney disease(MIX group,n=142)and diabetic kidney diseaseonly(DKD group,n=221)according to pathological results.Baseline data(diabetes duration,history of retinopathy,etc.)were recorded and biochemical indicators such as fasting blood glucose,glycated hemoglobin A1c,serum creatinine were detected.The estimated glomerular filtration rate(eGFR)was calculated.Endpoint renal events were defined as end-stage kidney disease,a persistent 40%decline of eGFR from baseline or all-cause mortality.The cumulative renal survival rate was analyzed by Kaplan-Meier analysis.Logistic regression analysis and Cox regression analysis were used to predict related factors of NDKD and to explore the risk factors for adverse renal outcomes.Results The mean age at baseline of 363 patients was(50.0±9.9)years and 233(64.2%)were male.No significant difference was found in gender and age between MIX and DKD groups.Logistic regression analysis showed that diabetes duration≤5 years[odds ratio(OR):2.136,95%confidence interval(CI):1.315-3.471,P<0.01],higher eGFR(OR:1.999,95%CI:1.246-3.209,P<0.01)and no anemia(OR:2.596,95%CI:1.614-4.175,P<0.01)were independently correlated with the presence of NDKD in patients with type 2 diabetic kidney disease.After 1∶1 matching by sex,age,duration of diabetes and renal function,there was no significant difference in prognosis between MIX and DKD groups(Log-rankχ²=1.138,P=0.286).The presence of retinopathy[hazard ratio(HR):2.162,95%CI:1.056-4.428,P=0.035]and urinary protein excretion rate≥3.5 g/24 h(HR:2.387,95%CI:1.018-5.552,P=0.045)were independent risk factors for adverse renal outcomes of patients in MIX group.Conclusion DKD patients with shorter duration of diabetes,higher eGFR and no anemia seems more likely to be complicated with NDKD.