糖尿病肾病微量白蛋白尿患者肾脏组织损伤及病情变化的研究

发布时间：2017-12-27 14:10

本文关键词：糖尿病肾病微量白蛋白尿患者肾脏组织损伤及病情变化的研究　出处：《肾脏病与透析肾移植杂志》2015年03期 　论文类型：期刊论文

【摘要】：目的:观察影响2型糖尿病肾病(DN)患者尿微量白蛋白(MAU)进展和缓解的临床与病理因素,并分析其对肾小球滤过率(GFR)下降的影响。方法:纳入尿白蛋白定量30~300 mg/24h,血清肌酐≤109.62μmol/L,并愿意接受肾活检的2型DN患者61例。记录患者一般情况(基线年龄、糖尿病病程等)、临床指标(e GFR、血脂、血糖、尿白蛋白定量等)及病理指标(肾小球体积、系膜区面积百分比、基膜厚度、足细胞足突宽度等)。结果:61例患者中失访7例,MAU进展组22例(40.74%),MAU稳定组25例(46.30%),MAU转阴组7例(12.96%)。MAU转阴组患者基线尿白蛋白定量显著低于稳定组和进展组[(103.05±53.88)mg/24h vs(139.58±76.88)mg/24h vs(192.58±97.64)mg/24h,P=0.025],高密度脂蛋白水平显著高于稳定组和进展组[(1.38±0.34)mmol/L vs(0.94±0.23)mmol/L vs(1.04±0.37)mmol/L,P=0.006],足细胞裂孔膜分布密度显著高于稳定组和进展组[(1.01±0.21)个/μm vs(0.78±0.21)个/μm vs(0.58±0.30)个/μm,P=0.003]。多因素COX回归分析,显示足细胞裂孔膜分布密度(HR=0.029,P0.001)和肾小球体积(HR=0.513,P=0.018)是MAU进展的独立影响因素;糖尿病病程(HR=0.925,P=0.012)、血尿酸(HR=1.012,P=0.034)、总胆固醇(HR=4.235,P=0.021)、ACEI/ARB使用(HR=311.451,P=0.006)是MAU转阴/缓解的独立影响因素。多因素Logistic回归分析显示,基线e GFR(HR=0.853,P=0.010)、血尿酸(HR=1.019,P=0.016)是e GFR下降的独立危险因素。结论:临床表现MAU的2型DN患者基线临床病理指标能够预测MAU进展与缓解,基线e GFR和血尿酸能够预测e GFR下降。
[Abstract]:Objective: To observe the clinical and pathological factors affecting the progression and remission of urinary microalbumin (MAU) in patients with type 2 diabetic nephropathy (DN), and to analyze their effects on the decline of glomerular filtration rate (GFR). Methods: a total of 30~300 mg/24h urinary albumin, serum creatinine is less than 109.62 mol/L, and 61 to type 2 DN patients received renal biopsy cases. The general condition of patients (baseline age, diabetes duration, etc.), clinical indicators (E GFR, blood lipids, blood sugar, urinary albumin quantitation, etc.) and pathological indicators (glomerular volume, percentage of mesangial area, basement membrane thickness, podocyte width of podocyte) were recorded. Results: 7 cases were lost in 61 cases, 22 cases in MAU progressive group (40.74%), 25 cases in MAU stable group (46.30%), 7 cases in MAU conversion group (12.96%). MAU negative patients baseline urinary albumin excretion was significantly lower than that of the stable group and progressive group [(103.05 + 53.88) mg/24h vs (139.58 + 76.88) mg/24h vs (192.58 + 97.64) mg/24h, P=0.025], high density lipoprotein level was significantly higher than that of stable group and progressive group [(1.38 + 0.34) mmol/L vs (0.94 + 0.23) mmol/L vs (1.04 + 0.37) mmol/L, P=0.006], podocyte slit diaphragm density was significantly higher than that of stable group and progressive group [(1.01 + 0.21) / M vs (0.78 + 0.21) / M vs (0.58 + 0.30) / m, P=0.003]. Multivariate COX regression analysis showed that podocyte slit diaphragm density (HR=0.029, P0.001) and glomerular volume (HR=0.513, P=0.018) were independent factors affecting the development of MAU; the duration of diabetes (HR=0.925, P=0.012), blood uric acid (HR=1.012, P=0.034), total cholesterol (HR=4.235, P=0.021), ACEI/ARB (HR=311.451 P=0.006) is MAU negative / independent effect mitigating factor. Multiple factor Logistic regression analysis showed that the baseline e GFR (HR=0.853, P=0.010), and blood uric acid (HR=1.019, P=0.016) were independent risk factors for the decrease of E GFR. Conclusion: the baseline clinicopathological indicators of type 2 DN patients with clinical manifestation of MAU can predict MAU progression and remission. Baseline e GFR and blood uric acid can predict a decline in E GFR.
【作者单位】：南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科
【基金】：国家科技支撑计划课题(2013BAI09B04,2015BAI12B05) 江苏省临床医学中心项目(BL2012007)
【分类号】：R587.2;R692
【正文快照】： 糖尿病肾病(DN)是2型糖尿病的严重并发症,也是导致终末期肾病的主要病因[1,2]。尿白蛋白排泄增加是DN的早期临床表现,尿白蛋白增加不仅与肾小球滤过率(GFR)快速下降密切相关,而且是DN患者心血管并发症的重要风险因素[3]。长期以来,DN被认为是一种不可逆的进展性疾病,尿微量白

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