2型糖尿病肾脏疾病与2型糖尿病合并非糖尿病肾病的临床病理比较

发布时间：2018-05-17 06:19

  本文选题：糖尿病 + 微量白蛋白尿　； 参考：《吉林大学》2017年硕士论文

【摘要】：目的:分析比较2型糖尿病肾脏疾病与2型糖尿病合并非糖尿病肾病的临床及病理特征,探索2型糖尿病合并非糖尿病肾病临床预测因子及其预测价值。方法:回顾性分析2010年11月至2016年10月于吉林大学第一医院住院接受肾穿刺活检术,且临床诊断为2型糖尿病伴有显性白蛋白尿的146例患者的临床和病理资料,所有对象符合入选标准,且具有完整的一般临床资料及实验室指标。按病理资料将患者分为典型糖尿病肾小球病组(DG组,n=30例),不典型糖尿病相关肾病组(ADRD组,n=6例),非糖尿病肾病组(NDRD组,n=110),分析比较典型糖尿病肾小球病组、不典型糖尿病相关肾病组和非糖尿病肾病组之间的临床及病理特点。探讨2型糖尿病合并非糖尿病肾病临床预测因子,同时通过计算ROC曲线下面积、计算灵敏度、特异度、总符合率、阳性预测值和阴性预测值对鉴别NDRD的临床因子预测价值进行评估。采用SPSS22.0软件进行统计学分析。结果:1、我院2010年11月至2016年10月行肾穿刺活检术,且临床诊断为2型糖尿病伴有显性白蛋白尿的146例患者,非糖尿病肾病在2型糖尿病肾损害中占比75.3%,病理类型以膜性肾病最多,临床表现以肾病综合征为主。2、典型糖尿病肾小球病组较非糖尿病肾病组糖尿病病程长,糖尿病视网膜病变发生率多、分期高,收缩压、平均动脉压高,eGFR低,差异具有统计学意义(p0.05)。不典型糖尿病相关肾病组和非糖尿病肾病组相比较,糖尿病视网膜病变发生率多、分期高,血清Cys-C水平低,高血压发生率小,差异具有统计学意义(p0.05)。3、2型糖尿病肾病患者糖尿病视网膜病变阳性率67.7%,非糖尿病肾病组中阳性率为22.8%,非糖尿病肾病组以非增殖期糖尿病视网膜病变为主要临床表现。4、糖尿病病程5年、不伴糖尿病视网膜病变、血尿、eGFR≥60 ml/min/1.73m~2对鉴别诊断非糖尿病肾病有预测价值,其中糖尿病病程5年预测价值最大。结论:1、典型糖尿病肾小球病和不典型糖尿病相关肾病组较非糖尿病肾病组糖尿病病程长,糖尿病视网膜病变发生率多、分期高。典型糖尿病肾小球病较非糖尿病肾病组收缩压、平均动脉压高,eGFR低。不典型糖尿病相关肾病组与非糖尿病肾病组相比较,高血压发生率小。2、非糖尿病肾病在2型糖尿病肾损害患者中占比较大(75.3%),病理类型以膜性肾病最多,临床表现以肾病综合征为主。3、糖尿病病程5年、不伴糖尿病视网膜病变、血尿、eGFR≥60ml/min/1.73m~2对鉴别诊断非糖尿病肾病有预测价值,其中糖尿病病程5年预测价值最大。
[Abstract]:Objective: to compare the clinical and pathological features of type 2 diabetic nephropathy and type 2 diabetes mellitus with non-diabetic nephropathy, and to explore the clinical predictive factors and their predictive value of type 2 diabetes mellitus with non-diabetic nephropathy. Methods: the clinical and pathological data of 146 patients with type 2 diabetes mellitus with dominant albuminuria were analyzed retrospectively from November 2010 to October 2016 in the first Hospital of Jilin University. All subjects met the selection criteria and had complete general clinical data and laboratory indicators. According to the pathological data, the patients were divided into typical diabetic glomerular disease group (DG) group (n = 30), atypical diabetic associated nephropathy group (n = 6), ADRD group (n = 6) and NDRD group (n = 11010). Clinical and pathological features between atypical diabetic nephropathy and non-diabetic nephropathy. To investigate the clinical predictive factors of type 2 diabetes mellitus complicated with non-diabetic nephropathy, and to calculate the area under ROC curve, the sensitivity, specificity, and the total coincidence rate. Positive predictive value and negative predictive value were used to evaluate the predictive value of clinical factors in differentiating NDRD. SPSS22.0 software was used for statistical analysis. Results from November 2010 to October 2016, we performed renal biopsy in 146 patients with type 2 diabetes mellitus with dominant albuminuria. Non-diabetic nephropathy accounted for 75.3% of renal damage in type 2 diabetes mellitus. The most pathological types were membranous nephropathy, and the clinical manifestations were mainly nephrotic syndrome. The course of diabetes in typical diabetic glomerulonephritis group was longer than that in non-diabetic nephropathy group. The incidence of diabetic retinopathy was high, the stage was high, the systolic pressure was high, the mean arterial pressure was high and eGFR was low, the difference was statistically significant (P 0.05). Compared with the non-diabetic nephropathy group, the incidence of diabetic retinopathy was higher, the level of serum Cys-C was low, and the incidence of hypertension was lower in atypical diabetic nephropathy group. The positive rate of diabetic retinopathy in type 2 diabetic nephropathy patients was 67.7%, the positive rate in non-diabetic nephropathy group was 22.8. the main clinical manifestation of non-proliferative diabetic retinopathy group was non-proliferative diabetic retinopathy. (4) the duration of diabetes is 5 years, Without diabetic retinopathy, hematuria eGFR 鈮，

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