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.

Pathological and clinical analysis of type 2 diabetes complicated with renal disease: report of 52 cases

Objective To analyze the relationship between pathological diagnosis and clinical manifestation, and to investigate the importance of renal biopsy on the diagnosis of type 2 diabetic patients complicated with renal diseases. Methods The chnical and pathological data of 52 type 2 diabetic patients with abnormal urinalysis or increased serum creatinine who had renal biopsy performed in our department were studied. Results Among 52 patients, 32 cases were distinctly diagnosed as diabetic nephropathy (DN), including 3 presenting with diabetic nephropathy complicated with non-diabetic renal disease (NDRD), and 20 with the NDRD only. The preoperative diagnosis of 24 cases (46.15%) was accordant with the diagnosis after renal biopsy, while 10 cases (19.23%) were misdiagnosed. Between the two groups, except the differences in blood urea nitrogen, serum creatinine, diabetic duration and whether the patients were complicated with diabetic retinopathy, other clinical manifestations and laboratory findings were not significantly different. Conclusions Type 2 diabetes complicated with proteinuria may result from NDRD. It is difficuh to differentiate the renal pathological changes merely by analyzing the clinical data. Therefore, renal biopsy is an important tool to confirm renal pathological changes.