西藏地区糖尿病肾病的临床病理特征及预后分析

The clinicopathological characteristics and prognosis of diabetic nephropathy in Tibetan area

目的总结分析西藏地区糖尿病肾病(diabetic nephropathy,DN)的临床病理和预后特点。方法回顾性分析2016年4月至2019年12月期间在西藏自治区人民医院肾脏内科行肾穿刺活检证实存在DN患者的临床病理及随访资料,将其按照病理分型分为4个亚组进行比较,并根据是否发生结局事件分成2个亚组进行分析,结局事件定义为需要肾脏替代治疗或死亡。结果共纳入48例患者,男性37例(77.08%),年龄(53.60±10.22)岁,肾穿刺活检时24 h尿蛋白定量为(4.59±2.19)g,血肌酐为(167.87±110.79)μmol/L。病理类型Ⅱa型7例,Ⅱb型6例,Ⅲ型30例,Ⅳ型5例,Ⅲ型患者尿蛋白水平较高,Ⅳ型患者血尿酸水平较高。随访时间(10.70±8.64)个月,随访期间6例患者进入肾脏替代治疗,12例患者死亡。无结局事件中位生存时间为15个月,1年和2年无事件累积生存率分别为67.8%和33.1%。出现结局事件组患者年龄更大、血白蛋白水平更低、肾穿刺活检时肾功能更差。结论西藏DN患者起病年龄早、肾穿刺活检时机晚、预后较差。当地医师需要更早期进行肾活检,加强对患者的宣教和管理,以改善患者预后。

Objective To analyze and summarize the clinicopathological characteristics and prognosis of diabetic nephropathy(DN)in Tibetan area.Methods Patients with biopsy-confirmed DN at Tibet Autonomous Region People's Hospital from April 2016 to December 2019 were recruited in this study.Their clinical,pathological and follow-up data were retrospectively analyzed.All the patients were divided into 4 groups based on the pathological types of DN to compare between groups.In addition,they were divided into 2 groups based on occurrence of outcome event to analyze,where the outcome event was defined as need for renal replacement treatment or death.Results A total of 48 patients were enrolled,including 37 males(77.08%),with an average age of(53.60±10.22)years.In time of renal puncture biopsy,the mean 24-hour urinary protein was(4.59±2.19)g and the mean serum creatinine was(167.87±110.79)μmol/L.There were 7 cases with pathological typeⅡa,6 cases with pathological typeⅡb,30 cases with typeⅡI,and 5 cases with type IV in terms of DN pathological typing.Patients with typeⅡI had higher urinary protein levels,and patients with type IV had higher serum uric acid levels.Mean follow-up duration was(10.70±8.64)months.During the follow-up period,6 patients received renal replacement therapy(RRT)and 12 patients died.The median event-free survival time was 15 months;the 1-year and 2-year event-free cumulative survival rate were 67.8%and 33.1%,respectively.The patients with outcome events had an older age,a lower serum albumin level and lower renal functions in time of renal puncture biopsy.Conclusions DN patients in Tibet have an early onset age,late timing of kidney biopsy,and poor prognosis.Local physicians should conduct renal biopsy for those patients,and enhance education and management of patients,so as to improve the prognosis.