老年2型糖尿病合并非糖尿病肾病患者的临床及病理分析

发布时间：2018-02-12 21:12

本文关键词： 糖尿病肾病型糖尿病肾活检组织病理学　出处：《中国老年学杂志》2017年08期 　论文类型：期刊论文

【摘要】：目的探讨老年2型糖尿病(T2DM)伴单纯糖尿病肾病(DN)、非糖尿病肾病(NDRD)和DN合并NDRD的临床及病理特点。方法回顾性分析住院行肾活检的70例老年T2DM患者的临床及病理资料,详细比较DN、NDRD、DN+NDRD三组的临床及病理特点,并与同期203例非老年T2DM患者的临床及病理资料进行对比。结果按病理分型的3个亚组:DN亚组占25.27%〔(14+55)/273〕,NDRD亚组占63.74%〔(44+130)/273〕,DN+NDRD亚组占10.99%〔(12+18)/273〕。其中,DN亚组老年患者占5.13%,非老年患者占20.15%;NDRD亚组老年患者占16.12%,非老年患者占47.62%;DN+NDRD亚组老年患者占4.39%,非老年患者占6.59%。总体上老年组的DM病史、肾衰竭发生率明显高于非老年组,而老年组体重指数(BMI)、肾小球滤过率(e GFR)、血清白蛋白水平明显低于非老年组(P0.05)。老年组DN亚组的肾衰竭发生率明显高于非老年组,而BMI、24 h尿蛋白定量(UP)明显低于非老年组;老年组的NDRD亚组肾衰竭发生率明显高于非老年组,而BMI、e GFR明显低于非老年组(P0.05);老年组DN+NDRD亚组的肾病综合征发病率和24 h-UP明显高于非老年组。老年组内DN亚组的24 h-UP、BMI明显低于DN+NDRD亚组;NDRD亚组DM病史、24 h-UP明显低于DN+NDRD亚组。非老年组内DN亚组的DM病史、24 h-UP明显高于NDRD亚组,而BMI、e GFR低于NDRD亚组;非老年组内DN亚组的24 h-UP明显高于DN+NDRD亚组,而血清白蛋白明显低于DN+NDRD亚组;非老年组内NDRD亚组的24 h-UP、血清白蛋白低于DN+NDRD亚组。病理诊断方面,老年组、非老年组及两组的NDRD亚组中,膜性肾病占的比例都是最大,Ig A肾病次之。在老年组和非老年组的DN+NDRD亚组中,高血压肾小动脉硬化是最常见的病理类型。结论老年T2DM中NDRD并不少见,DN、NDRD及DN+NDRD的临床表现难以鉴别,只有通过肾活检才能最终明确DN、NDRD和DN+NDRD的诊断。为提高老年T2DM患者肾脏疾病的缓解率和存活率,还需要大型、多中心、随机的前瞻性研究明确老年T2DM患者的肾脏病变特点。
[Abstract]:Objective to investigate the clinical and pathological features of type 2 diabetes mellitus (T2DM) with simple diabetic nephropathy (DN) and DN with NDRD. Methods the clinical and pathological data of 70 elderly T2DM patients who underwent renal biopsy were retrospectively analyzed. The clinical and pathological features of DN NDRD group were compared in detail. The clinical and pathological data of 203 non-elderly patients with T2DM were compared with that of the same period. Results according to the pathological classification, the three subgroups: DN subgroup: DN subgroup accounted for 25.27555 / 273D subgroup and 63.74743% NDRD subgroup, accounted for 10.9912 1818 / 273C group, of which DN subgroup accounted for 5.13% and non-elderly patients accounted for 5.13%. The percentage of elderly patients, non-elderly patients, non-elderly patients and non-elderly patients were 16.12, 4.39 and 6.59 respectively. The incidence of renal failure in the elderly group was significantly higher than that in the non-elderly group, and the body mass index (BMI), glomerular filtration rate (GFRN) and serum albumin level in the elderly group were significantly lower than those in the non-elderly group (P 0.05), and the incidence of renal failure in the DN subgroup in the elderly group was significantly higher than that in the non-elderly group. The incidence of renal failure in the elderly group was significantly higher than that in the non-elderly group, and the incidence of renal failure in the elderly group was significantly higher than that in the non-elderly group. The incidence of nephrotic syndrome and 24h-UP in DN NDRD subgroup were significantly higher than those in non-elderly group, and 24 h-UP in DN subgroup was significantly lower than that in DN NDRD subgroup. In DN NDRD subgroup, the DM history in DN subgroup was significantly higher than that in NDRD subgroup. The 24 h-UP in DN subgroup was significantly higher than that in DN NDRD subgroup, and the serum albumin level in NDRD subgroup was significantly lower than that in DN NDRD subgroup, and the serum albumin in NDRD subgroup was lower than that in DN NDRD subgroup. The proportion of membranous nephropathy in the elderly group, non-elderly group and NDRD subgroup of both groups was the largest in IgA nephropathy group, and in the DN NDRD subgroup in the elderly group and non-senile group, the proportion of membranous nephropathy was the highest in the elderly group and the non-senile group. Conclusion the clinical manifestations of NDRD and DN NDRD are not uncommon in elderly patients with T2DM. In order to improve the remission rate and survival rate of renal diseases in elderly patients with T2DM, a large, multicenter, randomized prospective study was needed to determine the characteristics of renal lesions in elderly patients with T2DM.
【作者单位】：吉林大学第二医院肾病内科;
【基金】：吉林省科技厅国际合作资助项目(No.20140414030GH)
【分类号】：R587.2;R692.9

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