伴与不伴水肿的糖尿病肾病患者的临床与病理特征

发布时间：2017-12-27 07:49

本文关键词：伴与不伴水肿的糖尿病肾病患者的临床与病理特征　出处：《第三军医大学学报》2016年08期 　论文类型：期刊论文

【摘要】：目的探讨伴与不伴水肿的糖尿病肾病(diabetic nephropathy,DN)患者的临床与病理特征。方法将病理诊断明确的170例DN患者分成水肿型DN组(edema DN,E-DN)和非水肿型DN组(nonedema DN,NE-DN),比较两组患者的临床和病理特征及预后间的差异。结果与基线值比较,E-DN组肾脏病理改变重,糖化血红蛋白(Hb A1c)、血压(BP)、总胆固醇(TC)、24 h尿蛋白定量3.5 g的百分比等均显著高于NE-DN组(P0.05,P0.01),而e GFR和血浆白蛋白(ALB)、尿比重、尿渗透压等均显著低于NE-DN组(P0.05,P0.01)。随访2年,E-DN组e GFR下降速率均显著大于NEDN组(P0.05),肾脏终点事件发生率、肾外并发症发病率也显著高于NE-DN组(P0.05)。生存分析显示E-DN组预后差(χ~2=17.460,P0.01)。危险因素分析发现肾活检时ALB(RR=0.938,P=0.004)、e GFR(RR=0.985,P0.01)、肾脏间质病变(RR=1.236,P=0.012)、TC(RR=1.192,P=0.015)、水肿(RR=6.412,P0.01)是DN肾脏死亡的独立危险因素。结论伴有水肿的DN患者较不伴有水肿的DN患者血糖控制较差、ALB低、脂质代谢紊乱、肾脏间质病变重、肾脏中位生存时间短,水肿为影响肾脏死亡的独立危险因素。
[Abstract]:Objective to investigate the clinical and pathological features of diabetic nephropathy (DN) patients with and without edema. Methods 170 cases of DN diagnosed by pathology were divided into edema group DN (edema DN, E-DN) and non edema type DN group (nonedema DN, NE-DN). The clinical and pathological characteristics and prognosis differences between the two groups were compared. Results compared with the baseline, the E-DN group of renal pathological changes, glycosylated hemoglobin (Hb A1c), blood pressure (BP), total cholesterol (TC), 24 h urine protein 3.5 g percentage were significantly higher than those of group NE-DN (P0.05, P0.01), e GFR (ALB) and plasma albumin, urine specific gravity and urine osmotic pressure were significantly lower than that of group NE-DN (P0.05, P0.01). After 2 years of follow-up, the descending rates of E GFR in group E-DN were significantly higher than those in group NEDN (P0.05), and the incidence of renal end events and incidence of extra renal complications were also significantly higher than those in group NE-DN (P0.05). The survival analysis showed that the prognosis of E-DN group was poor (x ~2=17.460, P0.01). Analysis of risk factors revealed that ALB (RR=0.938, P=0.004), e GFR (RR=0.985, P0.01), interstitial renal disease (RR=1.236, P=0.012), TC (RR=1.192, and P=0.015) and edema were the independent risk factors for renal death in renal biopsy. Conclusion DN patients with edema are more independent than those without edema. The patients with DN have poor blood glucose control, low ALB, lipid metabolism disorders, renal interstitial lesions and short median survival time. Edema is an independent risk factor for kidney death.
【作者单位】：第三军医大学新桥医院肾内科;
【基金】：国家自然科学基金面上项目(81370820)~~
【分类号】：R587.2;R692.9
【正文快照】： 2002年流行病学资料显示,我国18岁以上城市人口中糖尿病的患病率为4.5%,农村为1.8%[1]。随着肥胖人群的增加,2型糖尿病(type 2 diabeticmellitus,T2DM)的发病率有迅速升高之势。其最主要的微血管并发症为糖尿病肾病(diabetic nephropathy,DN),在西方国家已经成为引起终末期肾

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