伴发和未伴发水肿2型糖尿病肾病患者的临床与病理特征比较

摘要

目的 探讨伴发水肿2型糖尿病肾病患者的临床和病理特征.方法 选取2012年3月至2014年8月北海市人民医院收治的2型糖尿病肾病患者78例.根据患者是否发生水肿,将78例患者分为伴发水肿组59例和未伴发水肿组19例.比较两组患者的临床和病理特征.结果 伴发水肿组患者的空腹血糖、血肌酐(SCr)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、尿素氮(BUN)、24 h尿蛋白定量>3.5 g的人数比例、糖化血红蛋白(HbA1c)>6.5%的人数比例、糖尿病视网膜病变发生率均明显高于未伴发水肿组,差异均有统计学意义(P<0.05),而其白蛋白(ALB)、尿比重、尿渗透压、肾小球滤过率(eGFR)>60 mL/(min·1.73 m2)的人数比例明显低于未伴发水肿组,差异均有统计学意义(P<0.05);伴发水肿组和不伴发水肿组患者的肾小管间质评分在4~6分[47.5%(28/59)vs 21.1%(4/19)]、7分以上[27.1%(16/59)vs 5.3%(1/19)]的人数比较,伴发水肿组高于不伴发水肿组,差异均有统计学意义(P<0.05);伴发水肿组患者终末期肾病(ESRD)的发生率为27.1%(16/59),明显高于不伴发水肿组的5.3%(1/19),差异有统计学意义(P<0.05).结论 伴发水肿2型糖尿病肾病患者的血糖较高,肾小管间质病变较重,肾功能明显下降.%Objective To evaluate the clinical and pathological characteristics of type 2 diabetic nephropathy patients accompanied with edema. Methods Seventy-eight patients with type 2 diabetic nephropathy were selected from March 2012 to August 2014 in the People's Hospital of Beihai City, which were divided into edema group (59 cas-es) and non-edema group (19 cases) according to patients accompanied with edema or not. The clinical and pathological characteristics were compared between the two groups. Results The fasting blood glucose, serum creatinine (SCr), to-tal cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), blood urea nitrogen (BUN), the per-centage of 24 h urinary protein leakage over 3.5 g, the percentage of hemoglobin A1c (HbA1c)>6.5%and the incidence of diabetic mellitus retinopathy in the edema group were significantly higher than those in the non-edema group, P<0.05. However, the albumin (ALB), specific gravity, urine osmolality, and the percentage of estimated glomendar filtration rate (eGFR)>60 mL/(min·1.73 m2) in the edema group were significantly lower than those in the non-edema group, P<0.05. The percentage of patients scored 4~6 [ (47.5%(28/59) vs 21.1%(4/19)] and above 7 [27.1%(16/59) vs 5.3%(1/19)] in the edema group were significantly higher than those in the non-edema group, respectively, P<0.05. The incidence of end stage renal disease (ESRD) in the edema group (27.1%, 16/59) was significantly higher than that in the non-edema group (5.3%, 1/19), P<0.05. Conclusion Type 2 diabetic nephropathy patients accompanied with edema are character-ized with higher blood sugar, heavier renal tubular interstitial lesions, and significantly decreased renal function.