CAJ | 학술논문

目的分析2型糖尿病肾病患者肾脏病理改变与临床预后的相关性,探讨肾脏病理分型及病理指标对肾功能下降速率及相关结局事件的预测价值.方法 92例2型糖尿病肾病病例来自北京协和医院.根据患者肾脏病理改变特点分为糖尿病肾小球病(DG)和不典型糖尿病相关肾病(ADRD)2组.所有患者伴显性白蛋白尿,排除非糖尿病肾病,随访期≥6个月.回顾性队列分析2型糖尿病患者的肾脏病理改变及预后情况.结果随访期间DG组发生肾脏结局事件29例、死亡12例,ADRD组无终点事件发生;DG组血肌酐升高速率＞ADRD组(P＜0.05);两组患者生存率及肾生存率的差异有统计学意义(P＜0.05).病理类型为DG、GBM增厚、血管及小管间质病变严重程度等是肾脏结局事件的预测因子;系膜体积分数是独立于年龄及血肌酐的肾脏结局事件预测因子.结论糖尿病肾小球病和不典型糖尿病相关肾病患者的预后存在差异,推测二者可能具有不同的病理生理机制.肾脏病理改变类型、系膜体积分数等指标有助于预测2型糖尿病肾病患者的预后.
목적 분석2형당뇨병신병환자신장병리개변여림상예후적상관성,탐토신장병리분형급병리지표대신공능하강속솔급상관결국사건적예측개치.방법 92례2형당뇨병신병병례래자북경협화의원.근거환자신장병리개변특점분위당뇨병신소구병(DG)화불전형당뇨병상관신병(ADRD)2조.소유환자반현성백단백뇨,배제비당뇨병신병,수방기≥6개월.회고성대렬분석2형당뇨병환자적신장병리개변급예후정황.결과 수방기간DG조발생신장결국사건29례、사망12례,ADRD조무종점사건발생;DG조혈기항승고속솔＞ADRD조(P＜0.05);량조환자생존솔급신생존솔적차이유통계학의의(P＜0.05).병리류형위DG、GBM증후、혈관급소관간질병변엄중정도등시신장결국사건적예측인자;계막체적분수시독립우년령급혈기항적신장결국사건예측인자.결론 당뇨병신소구병화불전형당뇨병상관신병환자적예후존재차이,추측이자가능구유불동적병리생리궤제.신장병리개변류형、계막체적분수등지표유조우예측2형당뇨병신병환자적예후.
Objective To analyze the relationship between renal pathological characteristics and clinical prognosis in type 2 diabetic kidney disease patients,and discuss predictive value of pathological type and indexes for renal function declining rate and related outcome events.Methods Ninety-two type 2 diabetes patients from PUMC Hospital (with macroalbuminuria and followed up no less than 6 months,excluding patients with non-diabetic renal disease) were divided into typical diabetic glomerulopathy group (DG,n=51) and atypical diabetes-related renal disease group(ADRD,n=41) according to renal pathological findings.A retrospective cohort study was performed to investigate renal pathological features and prognosis.Results Total of 29 renal outcome events and 12 death events occurred in DG group and none in ADRD group; the survival rate and kidney survival rate are different between two groups (P ＜ 0.05); DG group,thick GBM,severe vascular and tubular lesion are predicative indicators for renal outcome event; mesangial volume fraction is predicative indicator for renal outcome events independent of age and serum creatinine.Conclusions DG and ADRD patients have different prognosis and might undergo different pathophysiological mechanisms; renal pathological type and mesangial volume fraction could help predicting outcomes of type 2 diabetic nephropathy patients.