2型糖尿病合并肾损害患者临床及病理特点分析

Analysis of clinical and pathological characteristics in patients with type 2 diabetes mellitus complicated with renal damage

该研究为回顾性研究。选取2015-2021年于西安交通大学第一附属医院肾脏内科合并2型糖尿病行肾活检的患者,统计并分析其肾脏病理和临床表现。纳入2型糖尿病行肾活检患者483例,包括既往无糖尿病、入院行口服葡萄糖耐量试验筛选出的新发糖尿病患者136例(28.16%),年龄(52.80±13.13)岁,男性337例(69.77%)。肾活检病理结果显示,糖尿病肾脏疾病(diabetic kidney disease,DKD)107例(22.15%),DKD+非糖尿病肾脏疾病(non-diabetic kidney disease,NDKD)32例(6.63%),NDKD 344例(71.22%)。膜性肾病为NDKD(40.41%,139/344)及DKD+NDKD(34.38%,11/32)中最常见的病理类型。136例新发糖尿病患者中,DKD 3例(2.21%),DKD+NDKD 2例(1.47%),NDKD 131例(96.32%)。糖尿病病史≤3个月、3~12个月、1~5年、5~10年及≥10年患者中,DKD占比分别为10.53%(6/57)、25.00%(16/64)、26.53%(26/98)、41.56%(32/77)及47.06%(24/51)。糖尿病病史≤3个月、3~12个月、1~5年、5~10年及≥10年患者中,DKD+NDKD占比分别为3.51%(2/57)、3.13%(2/64)、10.20%(10/98)、9.09%(7/77)和17.65%(9/51)。多因素Logistic回归分析结果显示,糖尿病病史(OR=1.130,95%CI 1.057~1.208,P<0.001)、糖尿病视网膜病变(OR=12.185,95%CI 5.331~27.849,P<0.001)、尿红细胞计数(OR=0.987,95%CI 0.974~0.999,P=0.039)、糖化血红蛋白(OR=1.482,95%CI 1.119~1.961,P=0.006)及血红蛋白(OR=0.973,95%CI 0.957~0.990,P=0.001)与DKD独立相关。随着糖尿病病史延长,DKD及DKD+NDKD比例均升高。膜性肾病为NDKD及DKD+NDKD中最常见的病理类型。即使新发2型糖尿病患者也有合并DKD可能,应早期进行DKD的筛查。糖尿病病史、糖尿病视网膜病变、尿红细胞计数、糖化血红蛋白及血红蛋白或可用于鉴别DKD与NDKD。

It was a retrospective study.The patients with type 2 diabetes mellitus(T2DM)who underwent renal biopsy in the Department of Nephrology,the First Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2021 were enrolled to analyze the pathological and clinical manifestations of kidney.There were 483 patients enrolled,including 136 patients who had no history of diabetes mellitus,newly diagnosed as T2DM according to an oral glucose tolerance test.The age was(52.80±13.13)years old.There were 337 males(69.77%).Based on the renal biopsy,the patients were classified as diabetic kidney disease(DKD,22.15%,107/483),DKD+non-diabetic kidney disease(NDKD)(6.63%,32/483),and NDKD(71.22%,344/483).Membranous nephropathy was the most common pathology in patients with NDKD(40.41%,139/344)and DKD+NDKD(34.38%,11/32).In the 136 newly diagnosed T2DM patients,there were 3 patients(2.21%)with DKD,2 patients(1.47%)with DKD+NDKD,and 131 patients with NDKD(96.32%).The proportions of DKD in patients with diabetes history≤3 months,3-12 months,1-5 years,5-10 years and≥10 years were 10.53%(6/57),25.00%(16/64),26.53%(26/98),41.56%(32/77)and 47.06%(24/51),respectively.The proportions of DKD+NDKD in patients with diabetes history≤3 months,3-12 months,1-5 years,5-10 years and≥10 years were 3.51%(2/57),3.13%(2/64),10.20%(10/98),9.09%(7/77)and 17.65%(9/51),respectively.Multivariate logistic regression analysis results showed that,the duration of diabetes history(OR=1.130,95%CI 1.057-1.208,P<0.001),diabetes retinopathy(OR=12.185,95%CI 5.331-27.849,P<0.001),urinary red blood cell count(OR=0.987,95%CI 0.974-0.999,P=0.039),glycosylated hemoglobin(OR=1.482,95%CI 1.119-1.961,P=0.006)as well as hemoglobin(OR=0.973,95%CI 0.957-0.990,P=0.001)were independently correlated with DKD.The proportions of DKD and DKD+NDKD increase with the prolongation of diabetes history.Membranous nephropathy is the most common pathology in NDKD and DKD+NDKD patients.Even in patients newly diagnosed with T2DM,it is necessary to screen for DKD.The duration of diabetes history,diabetes retinopathy,urinary red blood cell count,glycosylated hemoglobin and hemoglobin may be used to identify DKD from NDKD.