2型糖尿病合并肾损害实例解析及文献复习

发布时间：2018-02-11 13:59

  本文关键词： 2型糖尿病 糖尿病肾病 非糖尿病肾病 肾穿刺活检术 膜性肾病　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:近年来随着社会的发展,国民生活水平提高,受饮食习惯的改变及环境污染的影响,2型糖尿病(Type 2 Diabetes Mellitus,T2DM)的患病人数不断增加。糖尿病肾病(Diabetic Nephropathy,DN)作为糖尿病最常见的微血管病变之一,已成为国内仅次于慢性肾炎后导致终末期肾脏疾病(End Stage Renal Disease,ESRD)的第二大原因。然而糖尿病肾病绝大多数为临床诊断,随着超声引导下经皮肾脏穿刺活检技术的广泛开展,最终经病理证实合并非糖尿病肾病(Non-diabetic Renal Disease,NDRD)的2型糖尿病患者并非少见,这已引起国内外学者的广泛关注。本文通过阐述2型糖尿病合并非糖尿病肾病与糖尿病肾病两者之间在临床表现、病理特点、治疗方案及预后的不同,强调肾脏穿刺活检术对疾病明确诊断、制定治疗方案及评估预后的重要性。方法:选取1例就诊于河北医科大学第三医院肾内科的T2DM合并NDRD患者的临床病历资料,同时查阅国内外相关文献,归纳总结T2DM合并NDRD的发病率、临床表现、病理特点及治疗方案,以期为T2DM合并NDRD的诊断、治疗及预后评估提供帮助。结果:本例出现肾损害的T2DM患者,行超声引导下肾脏穿刺活检术后,病理证实为膜性肾病(Ⅰ期)。结论:T2DM合并NDRD的发生率较高,在临床工作中当T2DM患者出现肾损害时,应引起临床医师的重视,考虑到其存在NDRD的可能,必要时进行肾脏穿刺活检术以明确诊断,为后续的治疗提供帮助。
[Abstract]:Objective: in recent years, with the development of society, the standard of living of the people has improved. The number of patients with type 2 diabetes mellitus type 2 Diabetes Mellitusus T2DMwas increasing due to dietary changes and environmental pollution. Diabetic nephropathy (DN) is one of the most common microvascular lesions in diabetes. It has become the second leading cause of end Stage Renal disease after chronic glomerulonephritis in China. However, the majority of diabetic nephropathy is clinically diagnosed, with the extensive development of ultrasound guided percutaneous renal biopsy. It is not uncommon for type 2 diabetic patients to be pathologically proved to be associated with non-diabetic nephropathy (Non-diabetic Renal disease). This has attracted the attention of scholars at home and abroad. The differences of clinical manifestations, pathological features, treatment schemes and prognosis between type 2 diabetes mellitus complicated with non-diabetic nephropathy and diabetic nephropathy were discussed in this paper. The importance of renal biopsy in the diagnosis of disease, the formulation of treatment plan and the evaluation of prognosis were emphasized. Methods: the clinical medical records of 1 case of T2DM complicated with NDRD in the Department of Nephrology, third Hospital of Hebei Medical University were selected. At the same time, the incidence, clinical manifestation, pathological characteristics and treatment of T2DM combined with NDRD were summarized and summarized in order to diagnose T2DM with NDRD. Results: in this case of T2DM with renal damage, the pathologically proved membranous nephropathy (stage 鈪，

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