肾素-血管紧张素系统基因多态性与2型糖尿病患者慢性肾脏病的相关性研究

目的探讨血管紧张素原(AGT)及血管紧张素Ⅱ1型受体(AT1R)基因多态性与2型糖尿病患者慢性肾脏病(CKD)的关系。方法将76例患CKD的2型糖尿病患者,根据肾穿刺活检病理分为糖尿病肾病(DN)组(28例)、非糖尿病性肾病(NDRD)组(30例)和DN合并NDRD组(18例);另外选择30名健康体检者作为正常对照组。采用聚合酶链反应-限制性片段长度多态性技术方法检测上述研究对象的AGT基因M235 T多态性和AT1R基因A1166C多态性。结果NDRD组的主要病理类型是为膜性肾病和IgA肾病,DN+NDRD组NDRD的主要病理类型为膜性肾病、IgA肾病和高血压性肾小动脉硬化,两组NDRD的病理类型均无显著性差异(P0.05)。DN组和DN+NDRD组AGT基因M235 T-TT基因型频率明显高于NDRD组和正常对照组(P0.05),T等位基因频率明显高于NDRD组(P0.05)和正常对照组(P0.01),NDRD组和正常对照组比较以及DN组和DN+NDRD组比较AGT-TT基因型和T等位基因频率均无明显差异(P0.05)。各组AT1R基因A1166C多态性无显著性差异。AGT基因M235 T-TT基因型为2型糖尿病肾脏疾病患者eGFR下降的危险因素。结论AGT基因M235 T-TT基因型以及T等位基因与2型糖尿病患者DN及DN合并NDRD的发生有关,与NDRD的发生无关。AGT基因M235 T-TT基因型是2型糖尿病CKD患者肾功能减退的易感因素。AT1R基因多态性与2型糖尿病患者肾脏疾病的发生发展无关。     

2型糖尿病住院患者糖尿病肾脏疾病的发生率及危险因素分析

目的：分析2型糖尿病住院患者的糖尿病肾脏疾病（DKD）的发生率及危险因素,为临床糖尿病肾脏疾病的防治工作提供理论依据。方法：对2008年1月～2010年8月在上海交通大学附属第六人民医院内分泌代谢科住院的2型糖尿病患者测定血糖、肾功能、血脂谱、24h尿白蛋白等。应用简化肾脏病膳食改良试验（MDRD）公式计算肾小球滤过率（GFRMDRD）。所有患者均由眼科医生进行眼底摄片。按2007年美国肾脏病基金会（NKF）的糖尿病和慢性肾脏疾病的临床诊断治疗指南,将研究人群分为正常组（NCKD）、非糖尿病性肾脏疾病（NDRD）组及DKD组。结果：（1）共入选患者2225例,男1184例,女1041例;平均年龄为（60.5±11.7）岁。本研究人群中,DKD的发生率为15.4%,NDRD的发生率为18.5%。（2）DKD组患者的年龄、糖尿病病程、收缩压、血肌酐、总胆固醇（TC）、低密度胆固醇水平（LDL-C）、24h尿白蛋白量均显著高于NDRD组（P〈0.05）。（3）Logistic回归分析显示：糖尿病病程（OR=1.077,95%CI为1.059～1.096,P〈0.01）、收缩压（OR=1.039,95%CI为1.032～1.047,P〈0.01）、糖化血红蛋白（OR=1.092,95%CI为1.032～1.156,P〈0.01）、TC（OR=1.171,95%CI为1.050～1.306,P〈0.01）、HDL-C（OR=0.558,95%CI为0.369～0.844,P〈0.01）是DKD发生的独立危险因素。结论：为有效地延缓2型糖尿病肾脏病变的发生及发展,临床工作中要严格控制血压、血糖、血脂。     

慢性肾脏病3期糖尿病肾病与非糖尿病肾病患者贫血特点及影响因素分析

目的：评估慢性肾脏病3期（CKD3）糖尿病肾病（ON）与非糖尿病肾病患者之间贫血特点的差异及影响因素。方法：选取2012年2月～2013年5月在上海市第六人民医院肾内科住院的CKD3患者,其中糖尿病肾病42例。非糖尿病肾病患者49例,检测患者红细胞计数（RBC）、血红蛋白（Hb）、总蛋白（TP）、白蛋白（mb）、促红细胞生长素（EPO）、铁蛋白、总铁结合力、血清铁、叶酸、维生素B12、肌酐、尿素氮、钙、磷、甲状旁腺素、25羟维生素D3等指标进行对比分析。结果：42例CKD3期糖尿病肾病患者总的贫血发生率为67％,49例非糖肾组患者总的贫血发生率为39％。糖尿病肾病组红细胞计数、血红蛋白、白蛋白、血清铁均明显低于非糖肾组,组间差异具有统计学意义（P〈0.05）,DN组促红细胞生长素水平高于非DN组（P〈0.05）。结论：CKD3糖尿病肾病患者的贫血程度较非糖肾组严重,其贫血的发生与低蛋白血症、糖尿病肾外因素及铁代谢异常密切相关。     

2型糖尿病合并非糖尿病肾病的临床病理特征和预测因子的分析

目的:探讨2型糖尿病(type 2 diabetes mellitus, T2DM)合并非糖尿病肾病患者的临床指标和肾活检病理特征,寻找疾病的预测因子。方法:回顾性分析2016年07月—2021年12月在我院行肾活检的76例T2DM患者病例。根据活检结果分为糖尿病肾病(diabetic nephropathy, DN)组30例,非糖尿病肾病伴/不伴糖尿病肾病(non-diabetic renal disease with/without diabetic nephropathy, NDRD±DN)组46例,对其临床指标及病理结果进行分析。结果:两组患者的年龄、性别、糖尿病病程(diabetes mellitus, DM)、糖尿病视网膜病变(diabetic retinopathy, DR)、糖化血红蛋白、血红蛋白、血肌酐、尿素氮和胱抑素C比较差异有统计学意义(P<0.05)。肾活检常见原因有活动性尿沉渣,其次为DM<5年且无大量蛋白尿和新出现的肾病综合征。NDRD±DN组最常见的病理类型是膜性肾病,IgA肾病次之。二元Logistic回归分析发现性别、年龄、DR、糖化血红蛋...     

预测糖尿病患者并发糖尿病肾病风险的列线图模型的建立

目的探究2型糖尿病(type 2 diabetes mellitus,T2DM)患者并发糖尿病肾病(diabetic nephropathy,DN)的危险因素,开发和验证一种辅助临床预测DN的可视化评价工具。方法选取符合标准的2型糖尿病(T2DM)患者559例,其中单纯T2DM组(对照组)280例和合并微量白蛋白尿组(DN组) 279例。收集临床资料,采用单因素分析筛选DN相关因素,将有统计学意义变量纳入多因素Logistic回归模型,分析DN危险因素;应用R软件构建预测DN风险的列线图模型,采用Bootstrap法进行验证,并绘制ROC曲线,计算C-指数评估模型预测性能。通过绘制预测结果与实际结果的校正曲线,进行一致性测试。使用Hosmer-Lemeshow检验判断模型的拟合优度,P0.05表明模型的拟合优度较好。结果年龄、糖尿病病程、中性粒细胞计数、贫血、三酰甘油、体质量指数、糖尿病性周围神经病(diabetic peripheral neuropathy,DPN)、促甲状腺激素(thyroid stimulating hormone,TSH)与DN的发生有关(均P0.05),老年人、TSH4.6 mU/L、三酰甘油≥1.7 mmol/L、糖尿病性周围神经病、糖尿病病程1年是T2DM并发DN的独立危险因素(均P0.05),将这些因素纳入并成功构建了列线图。列线图模型预测效能好,ROC曲线下面积为0.852(95%CI=0.822～0.882),内部验证C-指数为0.846。校正曲线显示预测结果与实际结果的相关性良好(P=0.178)。结论本次研究构建的个体化预测DN早期患者风险的列线图模型,具有良好区分度,临床应用价值高,对甄别DN高风险人群,制订干预对策具有指导意义。     

2型糖尿病伴发非糖尿病性肾小球病变20例分析

糖尿病肾病是糖尿病的远期并发症之一,是糖代谢紊乱所致肾脏微血管病变的结果,具有独特的病理和临床特点.蛋白尿是糖尿病肾病(DN)最常见的临床表现之一 ,但是并非所有出现蛋白尿或者肾脏损害的糖尿病患者均属于DN.随着肾活检的开展,人们逐渐发现部分糖尿病患者的肾脏病变与糖尿病无关,而部分患者可以在糖尿病肾病的基础上同时合并其他的肾脏疾病,这就是所谓的糖尿病合并非糖尿病性肾脏疾病(NDRD).NDRD与DN 在病变性质,临床表现、治疗方法及预后均存在差异,本文通过对本院肾脏科近5年收治的2 0例NDRD患者的临床特点分析,以求提高对DM患者出现肾脏损害时的诊断与鉴别诊断水平, 为这类患者提供有效的诊治方案.     

Ⅱ型糖尿病患者并发骨质疏松症的患病情况及Logistic回归性分析

目的研究Ⅱ型糖尿病患者腰椎骨质疏松(osteoporsis,OP)患病情况,并进行相关因素的Logistic回归分析。方法纳入2017年1月~2018年5月于我院治疗的287例Ⅱ型糖尿病患者,采用双能X线骨密度仪测定患者腰L1-4节段骨密度,以骨密度T值-2.5 SD判定为骨质疏松,分别设为OP组与非OP组。调查两组患者性别、年龄等病历资料,经单因素分析、Logistic回归分析调查Ⅱ型糖尿病患者并发OP的独立危险因素。结果 287例患者发生OP 64例,发生率22.30%;两组患者性别、年龄、空腹C肽、糖化血红蛋白(HbA1c)、高胆固醇血症、病程、空腹血糖、餐后2 h血糖、促甲状腺激素、血钙水平,体重指数(BMI)平差异有统计学意义(P0.05);多因素Logistic回归分析显示,女性(OR=4.213,95%CI:1.324~15.674)、年龄55岁(OR=3.954,95%CI:1.311~13.767)、空腹C肽1.60μg/ml(OR=2.982,95%CI:1.121~9.457)、HbA1c9%(OR=3.343,95%CI:1.188~12.065)、高胆固醇血症(OR=2.676,95%CI:1.232~8.076)是Ⅱ型糖尿病患者发生OP的独立危险因素。结论Ⅱ型糖尿病患者并发OP发生率较高,女性、年龄55岁、空腹C肽1.60μg/ml、HbA1c9%、高胆固醇血症均是其独立危险因素。     

2型糖尿病患者罹患勃起功能障碍血管相关危险因素分析

目的:糖尿病性ED是糖尿病常见微血管并发症之一。对2型糖尿病患者罹患ED的与血管损害有关的危险因素进行分析,并建立列线图。方法:纳入181例2型糖尿病患者,进行性功能评估,并检索病例系统中患者血管损害相关的临床数据。数据经预处理后均采用各类的例数及百分数进行描述。采用R软件进行统计学分析。通过Lasso回归筛选出的可能的影响因素,在满足根据EPV方法计算Logistic回归分析所需样本量的前提下,将筛选的变量纳入多因素Logistic回归分析,并构建列线图;通过基于Bootstrap法的内部验证法利用C-指数、Calibration曲线、DCA决策曲线对列线图的区分度、校准度和临床有效性进行评价。结果:181例患者中有90例(49.7%)患者诊断为ED。纳入Logistic回归分析的危险因素为:糖尿病病程(OR=4.440, 95%CI=1.594～13.105; OR=7.667,95%CI=1.444～48.733)、颈动脉内膜中层厚度状态(OR=3.767, 95%CI=1.194～12.691)、合并糖尿病视网膜病变(OR=5.382, 95%CI=1.373～28.301)、合并糖尿病肾病(OR=4.959, 95%CI=1.156～27.728)、低密度脂蛋白胆固醇(OR=8.210, 95%CI=2.027～43.507)、红细胞分布宽度(OR=2.418, 95%CI=1.021～5.826)、血浆纤维蛋白原(OR=4.649, 95%CI=2.001～11.339)。C-指数为0.911(95%CI=0.869～0.954)。列线图的表观预测值分布曲线与Calibration图最佳曲线贴合良好。DCA曲线提示阈概率>6%以及<93%时选择该列线图对2型糖尿病罹患糖尿病性ED进行预测可临床获益。结论:本研究结合糖尿病病程、颈动脉内膜中层厚度状态、合并糖尿病视网膜病变、合并糖尿病肾病、低密度脂蛋白胆固醇、红细胞分布宽度、血浆纤维蛋白原这7项独立影响因素,初步建立了预测糖尿病患者罹患ED风险的列线图。     

早期糖尿病肾病的危险因素分析

目的:探索早期糖尿病肾病(DN)的危险因素,为临床防治早期DN提供参考依据。方法:多中心收集早期DN 182例(A组),以170例单纯糖尿病(DM,B组)为对照,收集年龄、病程、血压及腰臀比(WHR),检测血脂、糖化血红蛋白(HbA1c)及尿白蛋白(uAlb),计算尿白蛋白排泄率(UAER),进行统计学分析。结果:(1)两组比较:病程、SBP、DBP、WHR、HbA1c、TG、HDL、UAER差异有统计学意义(P<0.05,P<0.01),LDL、TC差异无统计学意义(P>0.05)。(2)以UAER为因变量,其他指标为自变量,进行logistic分析。其中病程、SBP、WHR、HbA1c先后被列入方程,为早期糖尿病肾病的独立危险因素(P<0.01)。(3)spearman相关分析显示:HbA1c与病程、TG,WHR与TG、HbA1c呈正相关(P<0.05)。结论:糖尿病病程、收缩压、腰臀比、糖化血红蛋白是早期DN的独立危险因素,严格控制血糖血压、减肥有利于延缓糖尿病肾病的进展。     

2型糖尿病并发慢性肾脏病临床病理特点分析

目的 研究2型糖尿病并发慢性肾脏病（CKD）患者的肾脏损害类型及临床特点。 方法 回顾性分析155例伴显性白蛋白尿的2型糖尿病患者的肾脏损害病理类型及临床特点。根据病理表现分为典型糖尿病肾小球病（DG）组、不典型糖尿病相关肾脏病（ADRD）组、非糖尿病肾病组（NDRD）和DG并发NDRD组。 结果 DG占18.7%,ADRD占12.9%,NDRD占60.0%,DG并发NDRD占8.4%。DG的糖尿病病程较长,空腹血糖较高,糖尿病视网膜病变（DR）发生率较高,收缩压和平均动脉压较高,尿蛋白量较多,GFR下降更明显。ADRD组年龄较小,体质量指数和肥胖比例较高。NDRD组多可见肉眼血尿和急性肾功能下降,对诊断NDRD有一定预测价值的因素有不伴DR、糖尿病病程小于5年、肉眼血尿、急性肾功能下降、自身免疫性疾病证据和尿蛋白量≥3.5 g/24 h且eGFR≥60 ml/min。 结论 2型糖尿病并发CKD的肾脏病理表现多样,NDRD常见,且与ADRD和DG有差异。如2型糖尿病并发慢性肾脏病患者出现以下任何1项：2型糖尿病病程少于5年、不伴DR、肉眼血尿史、急性肾功能下降、尿蛋白量≥3.5 g/24 h但eGFR≥60ml/min、有导致肾损害的系统性疾病证据,应考虑肾活检明确病理诊断。     

Renal pathology and clinical features of patients with type 2 diabetes mellitus and chronic kidney disease

Objective To retrospectively investigate the pathological and clinical characteristics of diabetic nephropathy and non-diabetic nephropathy diagnosed with renal pathology. Methods Data of 110 patients diagnosed as type 2 diabetes mellitus combined with chronic kidney disease (CKD) and conducted renal biopsy from January 2004 to December 2013 in our hospital were retrospectively analyzed. According to pathological diagnosis, patients were categorized into three groups: DN group, NDRD group and DN with NDRD group (MIX group). Results Membranous nephropathy was the most prevalent pathological type in NDRD group while IgA nephropathy was the major pathological type in MIX group. Compared with NDRD, DN patients had a higher anemia and diabetic retinopathy(DR) rate (all P＜0.05). The prevalence of having both nephrotic range proteinuria and kidney function decrease was higher in DN than NDRD (P＜0.05). Conclusions Renal pathology is important for the differential diagnosis of DN and NDRD since there is a relatively high rate of NDRD in patients with type 2 diabetes mellitus and CKD.     

Development and validation of a predictive model for the differential diagnosis of diabetic nephropathy and non-diabetic renal disease in patients with type 2 diabetes mellitus

Objective To develop and validate a predictive model for the differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) in patients with type 2 diabetes mellitus. Methods A retrospective study with patients with type 2 diabetes who underwent renal biopsy in the First Affiliated Hospital of Zhengzhou University from February 2012 to January 2015 was conducted. The dataset was randomly split into development (70.0%) and validation (30.0%) cohorts. Baseline predictors for model development was selected by using univariable and multivariable logistic regression. The model's performance in the two cohorts, including discrimination and calibration, was evaluated by the C-statistic, calibration curve and the P value of the Hosmer-Lemeshow test. Results Among the 931 patients with type 2 diabetes, 478 cases (51.3%) diagnosed as DN alone, 214 cases (23.0%) as NDRD alone and 239 cases (25.7%) as DN plus superimposed NDRD (MIX). Among NDRD and MIX patients, membranous nephropathy was the most common pathological type, followed by IgA nephropathy. The variables selected in the final predictive model were age, duration of diabetes, diabetic retinopathy, systolic blood pressure, hemoglobin, fasting blood glucose, glycosylated hemoglobin, cystatin C. The model performed well with good discrimination and calibration. The C-statistics were 0.913(95%CI 0.892-0.935) in the derivation cohort and 0.897(95%CI 0.876-0.919) in the validation cohort. The model had the best P value of 0.934 of the Hosmer-Lemeshow test. Conclusions A simple predictive model with high accuracy is constructed for predicting the presence of NDRD and MIX for type 2 diabetic patients. The nomogram can be used as a decision support tool to provide a non-invasive method for differential diagnosis of DN and NDRD, which may help clinicians assess the risk-benefit ratio of kidney biopsy for type 2 diabetic patients with renal impairment.     

A differential diagnostic model of diabetic nephropathy and non-diabetic renal diseases.

BACKGROUND: Renal diseases in diabetes include diabetic nephropathies (DN) and non-diabetic renal diseases (NDRD). The clinical differentiation between these two categories is usually not so clear and effective. This study aims to develop a quantified differential diagnostic model. METHODS: We consecutively screened the diabetic patients with overt proteinuria but no severe renal failure for kidney biopsy from 1993 to 2003. The finally enrolled 110 patients were divided into two groups according to pathological features (60 in DN group and 50 in NDRD group). Clinical and laboratory data were compared between two groups. Then a diagnostic model was developed based on the logistic regression analysis. RESULTS: Forty-six percent of patients were NDRD including a variety of pathological types. Many differences between DN and NDRD were found by comparison of the clinical indices. In the final logistic regression analysis, only diabetes duration (Dm), systolic blood pressure (Bp), HbA1c (Gh), haematuria (Hu) and diabetic retinopathy (Dr) showed statistical significance. Based on the logistic regression model: pi = e(z)/(1 + e(z)), a diagnostic model was constructed as follows: P(DN) = exp(-13.5922 + 0.0371Dm + 0.0395Bp + 0.3224Gh - 4.4552Hu + 2.9613Dr)/ [1 + exp(-13.5922 + 0.0371Dm + 0.0395Bp + 0.3224Gh - 4.4552Hu + 2.9613Dr)]. P(DN) was the probability of DN diagnosis (P(DN) >or= 0.5 as DN, P(DN) < 0.5 as NDRD). Validation tests showed that this model had good sensitivity (90%) and specificity (92%). CONCLUSIONS: This diagnostic model may be helpful to clinical differentiation of DN and NDRD in type 2 diabetic patients with overt proteinuria.     

507例2型糖尿病合并慢性肾脏病患者肾活检的临床病理特点

目的 总结和分析糖尿病肾病(diabetic kidney disease,DKD)与非糖尿病肾病(non-diabetic kidney disease,NDKD)患者临床病理特点,为临床2型糖尿病合并慢性肾脏病患者肾活检指征提供循证医学证据.方法 通过南方医科大学南方医院大数据库收集2002年2月至2018年6月在该院接受肾活检的2型糖尿病合并慢性肾脏病患者,并根据肾活检结果将其分为DKD组和NDKD组(包括DKD合并NDKD),比较两组间临床表现及病理类型特点,并采用Logistic回归模型分析DKD和NDKD患者的相关因素.结果 共纳入507例患者,DKD患者114例(22.5%),NDKD患者393例(77.5%).病理表现:NDKD的最常见病理类型为膜性肾病(30.0%)和IgA肾病(19.1%),其中有5.6%患者为DKD合并NDKD.临床表现:与NDKD组患者相比,DKD组患者有更长的糖尿病史(>1年,76.3%比36.1%,P<0.001),更易发生糖尿病视网膜病变(42.1%比4.8%,P< 0.001),24h尿蛋白量更高[3.69(1.70,6.74)g比2.21 (0.91,4.97)g,P<0.001],血肌酐更高[117.5 (85.8,194.5) μmol/L比89.0 (68.0,143.8) μmol/L,P<0.001],血红蛋白更低[(105.07±20.85) g/L比(124.41±25.02) g/L,P=0.002],胆固醇更低[(5.69±1.87) mmol/L比(6.43±2.75) mmol/L,P=0.001].Logistic回归分析显示,糖尿病史(OR=4.162,95%CI 1.717~10.098,P=0.002)、较高收缩压(每增加1 mmHg,OR=1.028,95%CI 1.011~1.045,p=0.001)、降压药服用史(OR=3.141,95%CI 1.496~6.591,P=0.002)、糖尿病视网膜病变(OR=5.561,95%CI2.361~13.100,P<0.001)、较高糖化血红蛋白(每增加1%,OR=1.680,95%CI1.333~2.118,P<0.001)是DKD的相关因素,而血尿(OR=2.781,95%CI 1.334~5.798,P=0.006)和较高血红蛋白(每增加1g/L,OR=1.022,95%CI1.008~1.037,P=0.002)则为NDKD的相关因素.结论 DKD与NDKD之间的临床表现及病理类型存在差异,糖尿病病史、眼底检查、大量蛋白尿、降压药服用史、较高的糖化血红蛋白水平对DKD的诊断有较好的预测作用,而血尿和较高的血红蛋白水平对NDKD的诊断有一定指导意义.糖尿病合并慢性肾脏病患者行肾活检的指征需根据各临床表现综合分析.     

Renal pathological change in patients with type 2 diabetes is not always diabetic nephropathy: a report of 52 cases

AIMS: The present study examined the relationship between clinical features and renal histological changes in the Type 2-diabetic patients and evaluated the usefulness of renal biopsy in the diagnosis of diabetic versus non-diabetic kidney disease. METHODS: 52 patients with Type 2-diabetic mellitus were retrospectively analyzed for differential clinical, laboratory features and pathological characteristics including overt proteinuria (> 0.5 g/day), elevated serum creatinine and/or the development of hematuria. RESULTS: Of 52 patients, 20 cases (38.5%) showed no detectable diabetic lesions and, thus, were diagnosed as non-diabetic renal disease (NDRD), while 32 patients (61.5%) exhibited diabetic nephropathy. Interestingly, while 29 patients showed diabetic nephropathy (DN) alone, NDRD was also found in 3 patients with DN. Clinically, 24 out of 52 patients (46.16%) had a diagnosis consistent with the pathological findings, while 10 (19.23%) were diagnosed incorrectly. Compared to NDRD patients, patients with DN had prolonged diabetic history with or without retinopathy, while 25% of patients with NDRD exhibited mesangial proliferative glomerulonephritis. CONCLUSIONS: NDRD was a common feature in Type 2-diabetic patients with renal involvement. The absence of retinopathy and short periods of diabetic history may be useful indicators for diagnosis of NDRD clinically.     

Diabetes mellitus as a cause or comorbidity of chronic kidney disease and its outcomes: the Gonryo study

Background

Diabetes mellitus (DM) is a major cause of end-stage kidney disease (ESKD). However, the difference in renal outcomes between DM patients with non-diabetic renal disease (DM and NDRD) and those with diabetic nephropathy (DN) is controversial. The aim of the present study was to evaluate the differences among patients with DN, DM, and NDRD, and non-DM chronic kidney disease (CKD) in a prospective observational study.

Methods

We extracted the data of 2484 patients from 11 nephrology care centers and categorized into three groups as described above. The primary outcome was ESKD requiring renal replacement therapy.

Results

During the median follow-up of 4.44 years, 281 patients (11.3%) developed ESKD. Renal outcomes of DM and NDRD patients were similar to those of non-DM patients (p ≥ 0.05). At CKD stage G3b, the hazard ratios (95% confidence intervals) of ESKD were 7.10 (2.46–20.49) in DN patients and 0.89 (0.19–4.24) in DM and NDRD. The annual change in the estimated glomerular filtration rate (eGFR) in DN patients was significantly larger than that in other groups at stage G3b (?9.7%/year).

Conclusions

We found that DN patients have a higher risk for ESKD than DM and NDRD or non-DM patients. In particular, GFR rapidly declined in DN at stage G3b. DM and NDRD patients can accomplish equally beneficial renal outcomes as non-DM CKD, regardless of their similar metabolic profiles as DN. In conclusion, we should prudentially consider the risk stratification of DM whether cause or comorbidity of CKD.

     

2型糖尿病合并肾脏损害的病理与临床分析

目的 分析2型糖尿病患者出现肾脏病变时病理诊断与临床表现的关系.探讨肾活检在2型糖尿病伴有肾脏病变诊断的意义.方法 分析52例尿检异常和（或）Scr升高的2型糖尿病患者的临床特征和病理改变特点.结果 52例2型糖尿病患者经肾活检,32例确诊为糖尿病肾病（DN）,占61.5%,其中3例为糖尿病肾病合并非糖尿病性肾脏疾病（NDRD）;余20例为非糖尿病性肾脏疾病,占38.5%.肾活检前后诊断符合率46.15%,误诊率19.23%.两组间除BUN、Scr、糖尿病病程和是否伴有糖尿病性视网膜病变有显著差异外,其他临床表现和实验室检查的差异均无统计学意义.结论 2型糖尿病伴肾脏病变时相当部分是非糖尿病性肾脏病变,单纯依靠临床资料常难以鉴别,肾活检对明确糖尿病伴肾病变的性质具有重要的意义.     

新疆墨玉县维吾尔族成人牙周炎与慢性肾脏病患病率的流行病学研究

目的 探讨维吾尔族成人牙周炎与慢性肾脏病（CKD）患病率的关系。 方法 采用分层容量随机抽样方法,从墨玉县364个村抽取15个村18岁以上维吾尔族成人1650人,进行问卷调查、慢性肾损伤指标检测、相关危险因素调查及口腔检查。依据慢性牙周炎的诊断标准,将调查对象分为牙周炎组和非牙周炎组,其中牙周炎组按其严重程度进一步分为轻度牙周炎组、中度牙周炎组和重度牙周炎组。 结果 在资料完整的1415人中,慢性牙周炎患病率为65.2％（95%CI：65.0～65.4）,CKD患病率为5.2%（95%CI：5.1～5.3）,蛋白尿的患病率为4.2%（95%CI：4.1～4.3）,慢性肾功能不全的患病率为1.3%（95%CI：1.3～1.4）。牙周炎组和非牙周炎组CKD患病率差异有统计学意义（6.4%比2.9%,χ2 = 7.841,P = 0.005）。单因素Logistic回归分析显示重度牙周炎为CKD的危险因素（OR = 3.2,95%CI：2.0～5.2）。多因素Logistic回归亦显示重度牙周炎是CKD发生的独立危险因素（OR = 1.9,95%CI：1.1～3.3）。 结论 新疆农村维吾尔族成人是牙周炎的高发人群。牙周炎人群CKD患病率明显高于非牙周炎人群。重度牙周炎是CKD的独立危险因素。