CAJ | 학술논문

目的鉴别2型糖尿病患者蛋白尿的肾脏病因,估算非糖尿病肾病的患病率.方法回顾性研究分析46例2型糖尿病合并肾损伤的患者,比较病史、心脏彩超、颈动脉多普勒彩超、眼底检查结果、肾小球滤过率、肝功能、肾功能、血脂、血糖、HbA1c、尿蛋白等临床指标,所有患者通过肾脏穿刺明确诊断,根据病理结果分为糖尿病肾病组和非糖尿病肾病组.结果 46例患者确诊糖尿病肾病比例占47.8%,52.2%患者是糖尿病合并其他肾小球疾病,即非糖尿病.肾病,在非糖尿病肾病组中以局灶节段肾小球硬化比例最高.糖尿病肾病组空腹血糖较高(P<0.05).心脏彩超各项指标中,糖尿病肾病组的射血分数显著低于非糖尿病肾病组(P<0.05).颈动脉彩超检测中发现,糖尿病肾病组存在动脉粥样斑块患者显著高于非糖尿病肾病组,其颈动脉内膜中层厚度均较非糖尿病肾病组高(P<0.05).值得注意的是,非糖尿病肾病与糖尿病视网膜病变关系不大,糖尿病视网膜病变对诊断糖尿病肾病具有较高的敏感性(72.2%)和特异性(91.7%,P<0.01).结论 2型糖尿病合并有蛋白尿时,空腹血糖、心脏射血分数、颈动脉粥样斑块和内膜中层厚度,以及眼底的改变作为临床鉴别糖尿病肾病和非糖尿病肾病的参考指标,肾活检则是明确糖尿病伴肾脏病变性质的重要手段.
목적 감별2형당뇨병환자단백뇨적신장병인,고산비당뇨병신병적환병솔.방법 회고성연구분석46례2형당뇨병합병신손상적환자,비교병사、심장채초、경동맥다보륵채초、안저검사결과、신소구려과솔、간공능、신공능、혈지、혈당、HbA1c、뇨단백등림상지표,소유환자통과신장천자명학진단,근거병리결과분위당뇨병신병조화비당뇨병신병조.결과 46례환자학진당뇨병신병비례점47.8%,52.2%환자시당뇨병합병기타신소구질병,즉비당뇨병.신병,재비당뇨병신병조중이국조절단신소구경화비례최고.당뇨병신병조공복혈당교고(P<0.05).심장채초각항지표중,당뇨병신병조적사혈분수현저저우비당뇨병신병조(P<0.05).경동맥채초검측중발현,당뇨병신병조존재동맥죽양반괴환자현저고우비당뇨병신병조,기경동맥내막중층후도균교비당뇨병신병조고(P<0.05).치득주의적시,비당뇨병신병여당뇨병시망막병변관계불대,당뇨병시망막병변대진단당뇨병신병구유교고적민감성(72.2%)화특이성(91.7%,P<0.01).결론 2형당뇨병합병유단백뇨시,공복혈당、심장사혈분수、경동맥죽양반괴화내막중층후도,이급안저적개변작위림상감별당뇨병신병화비당뇨병신병적삼고지표,신활검칙시명학당뇨병반신장병변성질적중요수단.
Objective To differentiate proteinuria due to non-diabetic renal diseases(NDRD)from that of diabetic nephropathy(DN)in type 2 diabetic patients,and to evaluate the prevalence of NDRD.Methods A retrospective analysis was performed on diabetic patients who had undergone renal biopsy between Jan 1,2003 and Dec 3 1,2006.The data including history of diabetes,cardiac color ultrasound,color Doppler ultrasound of the carotid artery,retinal changes,examination of ocular fundus,giomerular filtration rate,hepatic and renal function,lipid profile,blood glucose,HbA1c,and urine protein were collected.Results Among 46 patients,22 cases (47.8%)were distinctly diagnosed as diabetic nephropathy(DN),while the other 24(52.2%)as NDRD.Focal segmental glomeruloselerosis Was the most common lesion found in patients with NDRD.In DN group,the fasting blood glucose was higher than that of NDRD group,as well as ejection fraction,carotid plaque,and intimamedia thickness(IMT)showed significant differences between 2 groups.Patients with NDRD were less frequently associated with diabetic retinopathy.Diabetic retinopathy showed hiigh sensitivity(72.7%)and specificity (91.7%)in diagnosing DN.Conclusions Blood glucose,ejection fraction,carotid plaques and IMT,and retinopathy may be helpful in differential diagnosis of diabetic patients with overt proteinuria.Renal biopsy is an important step lo establish the diagnosis.