糖尿病患者合并肾脏损害的肾活检病理与临床研究

目的研究糖尿病合并肾脏损害患者肾活检病理类型特点及与临床的联系。方法回顾性分析1992年-2002年间64例行肾活检的糖尿病肾损害患者病理检查结果和临床资料,并与同期非糖尿病肾病患者的活检病理类型对比。结果糖尿病肾小动脉硬化症(DN)42 例(65．6％);良性肾小动脉硬化症(BNS)6例(9．4％);原发肾小球肾病(CGN)16例(25．0％), 其中2例在DN基础上合并CGN。CGN组病理类型分布为IgA肾病6例(37．5％),局灶节段性硬化(FSGS)6例(37．5％),微小病变型(MCND)2例(12．5％)和膜性肾病(MN)2例(12．5％),病理类型分布特点与同时期771例普通肾脏病人群肾活检病理类型分布大致相似,FSGS高于非糖尿病人群(分别为27．3％和4．7％,P<0．01)。与临床资料联系分析显示,DN及BNS组糖尿病病程较CGN长(P<0．01),且患者年龄大(P<0．05),而血糖和血压控制水平在DN组和其他两组无显著差异;BNS组尿蛋白量(0．45±O．33)g／d]明显低于DN组和CGN组分别为 (3．18±2．4)g／d、(2．68±1．27)g／d,P<0．01],而后两组没有显著差异;BNS组糖尿病视网膜病变发生率明显低于DN和CGN组(分别为0％、38．1％、37．5％、P<0．01),DN和CGN组无显著差异。结论糖尿病合并肾损害患者中原发性肾小球疾病的发生率为25％,且病理类型改变分布谱与普通肾病人群肾活检结果相似,因此糖尿病合并肾损害患者应尽早实施肾活检,以明确诊断,从而采用正确的个体化治疗。

Pathological and clinical study on biopsies from diabetic patients with renal damage

Objective To explore the relation between specific pathological features and clinical data in diabetic patients with renal damage. Methods Pathological features and clinical data were retrospectively analyzed in 64 diabetic patients with renal damage who underwent renal biopsy from 1992 to 2002. The pathological profiles were simultaneously compared with biopsies from non-diabetic patients during the same period. Results Patients were primarily divided into 3 groups according to their pathological features: the diabetic nephropathy (DN) group (42 cases， 65.6%)， the arterio-arteriolosclerosis and ischemic glomerular damage (BNS) group (6 cases， 9.4%)， and the primary glomerulonephritis (CGN) group (16 cases， 25.0%)， including 2 patients with glomerulonephritis superimposed on diabetic glomerulosclerosis. The specific pathological profiles of the CGN group were as following: IgA nephropathy 6 cases(37.5%)， focal segmental glomerulosclerosis (FSGS) 6 cases(37.5%)， minor change renal disease (MCND) 2 cases(12.5%)， and membranous nephropathy (MN) 2 cases (12.5%)， which were similar to those of non-diabetic patients， except that the ratio of FSGS was significantly increased (27.3% vs. 4.7%， P < 0.01). Linking with clinical data， DN and BNS groups had a longer diabetic duration than the CGN group (P < 0.05). The age of CGN groups was younger than that of other two groups (P < 0.05). No differences were showed in glucose and blood pressure levels among three groups. The amount of proteinuria in BNS group was significantly less than that of DN and CGN group(0.45±0.33) g/d vs. (3.18±2.40) g/d and (2.68±1.27) g/d， P < 0.01]， and the latter two groups were not different. Similarly， the retinopathy incidence of the BNS group was markedly lower than that of DN and CGN group (0% vs. 38.1% and 37.5%， P < 0.01)， and no difference was found between DN and CGN group. Conclusions The CGN incidence in diabetic patients with renal damage is 25%， and its pathological profiles are similar to those of non-diabetic patients. Diabetic patients with renal damage should undergo early renal biopsy to differentiate DN and CGN， which would be beneficial for patients’ individual treatment.