糖尿病肾病合并非糖尿病肾病患者的病理分析

摘要

Objective:To analyze the type 2 diabetic patients with clinical manifestation and pathological results,and to investigate the importance of renal biopsy on the diagnosis of diabetic nephropathy(DN).Method:Renal biopsy specimens were obtained from 61 patients with type 2 diabetes mellitus with albuminuria ,analyze their clinical markers and pathological results.Result:Among 61 cases,32 patients(52.5%) were DN,29 cases(47.5%) were (NDRD).The diabetic course,hematuria from glomerulus of kidney,diabetic retinopathy were significantly different(P<0.05),other markers had no significantly differences. IgA nephropathy was the most common,accounting for 31.0 % of group NDRD,membranous nephropathy ranked second accounting for 17.2 %,followed by mesangial proliferative nephritis 13.8%,hypertensive nephrosclerosis 13.8%,FSGS 10.3%,minimal change disease 6.9%,crescentic GN 3.5%,renal amyloidosis 3.5%.Conclusion:The present study showed that IgA nephropathy is the commonest NDRD among diabetics.Diabetic retinopathy and hematuria from glomerulus of kidney are important factors for diagnosing diabetic nepropathy.When we have no enough evidence to prove DN in clinical,renal biopsy is an important tool to distinguish and diagnosis NDRD and DN.%目的：分析2型糖尿病合并肾脏损害的临床资料及病理结果，探讨肾活检诊断糖尿病肾病的意义。方法：对61例伴有蛋白尿的2型糖尿病患者进行肾活检，分析其临床指标及病理结果。结果：61例患者中糖尿病肾病32例(52.5%)，非糖尿病肾病29例(47.5%)。两组患者糖尿病病程、肾小球源性血尿以及糖尿病视网膜病变比较差异有统计学意义(P<0.05)，其余指标无明显差异。所有合并的非糖尿病肾病中，以IgA肾病比例最高为31.0%，其他依次为膜性肾病17.2％，系膜增生性肾小球肾炎13.8％，高血压肾小球硬化13.8％，FSGS 10.3%，微小病变型肾小球肾炎6.9%，新月体性肾小球肾炎3.5%，肾淀粉样变性3.5％。结论：2型糖尿病合并蛋白尿时相当部分是非糖尿病肾脏病变，其中以IgA肾病最常见。糖尿病视网膜病变、肾小球源性血尿是诊断糖尿病肾病的重要影响因素，在临床诊断糖尿病肾病证据不足的前提下，肾活检对于糖尿病肾病和非糖尿病肾脏疾病的鉴别与诊断具有决定意义。