2型糖尿病合并不同病理分型肾病的眼底表现

Fundus manifestations of different types of nephropathy in type 2 diabetes mellitu

背景2型糖尿病合并不同类型肾病容易合并眼底病变,其早期诊断直接影响患者的治疗及预后。目的观察2型糖尿病合并不同病理分型肾病患者的特征性眼底表现,为临床诊断提供依据。方法回顾性分析2017年1月-2021年12月于解放军总医院第一医学中心眼科就诊的2型糖尿病合并肾病患者,均行眼底检查,根据病理分型分析眼底病变特点。结果共纳入124例患者,男性72例,女性52例,平均年龄(45.5±7.6)岁。根据病理结果分为7类肾病,眼底病变特点:糖尿病性肾病,眼底改变均呈现明显糖尿病性视网膜病变改变;膜性肾病,多无病理改变或仅见微血管瘤及后极部病变;免疫球蛋白A肾病,主要为视网膜动脉硬化轻度改变,或伴后极部病变;肾小球微小病变性肾病,表现为视网膜色素上皮病变;高血压性肾病,表现同高血压性视网膜病变;局灶性肾小球病变,眼底无异常,或仅见后极部病变;紫癜性肾病,特点为黄斑区微血管瘤,及静脉白线状改变。结论糖尿病合并不同病理分型肾病,除糖尿病肾病的眼底明确表现为糖尿病性视网膜病变,其他病理分型的肾病眼底均具有明显特征性表现,可为临床诊断提供前期依据。

Background Type 2 diabetes with different types of nephropathy is easy to be complicated with fundus lesions,and its early diagnosis directly affects the treatment and prognosis of patients.Objective To observe the fundus manifestations of type 2 diabetic patients with different types of nephropathy,so as to provide reference for clinical diagnosis.Methods Clinical data about type 2 diabetic patients complicated with nephropathy admitted to Department of Ophthalmology,the First Medical Center,Chinese PLA General Hospital from January 2017 to December 2021 were collected.The pathological classification of nephropathy was determined by renal biopsy.Fundus lesions were diagnosed by fundus examination.Results A total of 124 patients with type 2 diabetic patients complicated with nephropathy were selected.Seventy-two cases were male and 52 cases were female,with an average age of 45.5±7.6 years.Seven types of nephropathy were diagnosed by the pathology examination,and the the features of color fundus images varied.The fundus image of diabetes nephropathy(DN)showed obvious changes of diabetes retinopathy.Membrane nephropathy(IMN)had no pathological changes or only microangioma and posterior pole lesions.Immunoglobulin A nephropathy(IgAN),mainly with slight changes of retinal arteriosclerosis or with posterior pole lesions.Glomerular minimal change nephropathy(MCD)was characterized by retinal pigment epithelial disease.Hypertensive nephropathy was the same as hypertensive retinopathy,with focal glomerulopathy,no abnormality in fundus,or only posterior pole lesion.Purpura nephropathy was characterized by microangioma in the macular region and white line changes in veins.Conclusion The features of color fundus images of diabetes complicated with different pathological types of nephropathy are significantly different,and each type has specific manifestations.The identification of different fundus manifestations will benefit early diagnosis.