2型糖尿病肾病病理分型特点与尿蛋白的关系

目的 探讨2型糖尿病肾病患者各个分型的病理特征与尿蛋白的关系.方法 将确诊为2型糖尿病肾病(2TDN)的患者根据24小时尿蛋白分为A、B、C、D四组,分别为A蛋白尿组(尿蛋白/24h＜2000mg)、B蛋白尿组(尿蛋白/24h2000～＜4000mg)、C蛋白尿组(尿蛋白/24h 4000～6000mg)、D蛋白尿组(尿蛋白/24h＞ 6000mg).对四组患者分别检测尿素氮(BUN)、血肌酐(Scr)、白蛋白(Alb),光镜下分别观察各组患者肾组织HE、PAS、PASM、Masson染色结果变化,电镜下观察各组患者肾组织超微结构的改变以及测量各组肾小球基底膜厚度.结果 各组DN患者经病理分型后,A组Ⅰ型6例(20％),Ⅱa型7例(23％),Ⅱb型6例(20％),Ⅲ型10例(33％),Ⅳ型1例(3％);B组Ⅰ型2例(7％),Ⅱa型3例(10％),Ⅱb型10例(33％),Ⅲ型14例(47％),Ⅳ型1例(3％);C组Ⅰ型1例(3％),Ⅱa型3例(10％),Ⅱb型5例(17％),Ⅲ型20例(67％),Ⅳ型1例(3％);D组Ⅰ型0例(0％),Ⅱa型1例(3％),Ⅱb型3例(10％),Ⅲ型17例(57％),Ⅳ型9例(30％).B、C、D组与A组相比较,血清Alb皆降低,差异有统计学意义(P＜0.05);D组与A组相比较,血清BUN、Scr升高,差异有统计学意义(P＜0.05);D组与B、C组相比较,血清Alb皆降低,差异有统计学意义(P＜0.05),Scr升高,差异有统计学意义(P＜0.05).随着蛋白尿的升高,各组DN患者的基底膜厚度相应增加,病理分型也相应严重.结论 DN患者肾脏的病理变化与蛋白尿的进展有一定的内在联系,对DN患者进行病理分型,有助于深入了解患者病情,为早期诊断和治疗提供依据.

Relationship Between Pathological Classification and Proteinuria with Type 2 Diabetic Nephropathy

Objective To investigate the relationship between pathological classification and proteinuria with type 2 diabetic nephropathy.Methods 120 cases with type2 DN were enrolled in this study.Based on the urinary protein excretion,they were divided into four group.BUN,Scr and Alb were detected with biochemical method.Pathological changes in renal tissues were analyzed by HE staining,PAS staining,PASM staining and Masson staining.The ultramicrostructural changes of renal tissues were observed with an electron microscope.The glomerular basement membrane (GBM)width were evaluated by electron microscopic morphometry.Results Of the 120 patients studied.Renal biopsy showed following:type Ⅰ accounting for 20％ of A group,type Ⅱ a accounting for 23％ of A group,type Ⅱb accounting for 20％ of A group,type Ⅲ accounting for 33％ of A group,type Ⅳ accounting for 3 ％ of A group;type Ⅰ accounting for 7％ of B group,type Ⅱ a accounting for 10％ of B group,type Ⅱ b accounting for 33％ of B group,type Ⅲ accounting for 47 ％ of B group,typeⅣ accounting for 3 ％ of B group;type Ⅰ accounting for 3％ of C group,type Ⅱ a accounting for 10％ of C group,type Ⅱ b accounting for 17％ of C group,type Ⅲ accounting for 67％ of C group,typeⅣ accounting for 3 ％ of C group;type Ⅰ accounting for 0％ of D group,type Ⅱ a accounting for 3％ of D group,type Ⅱ b accounting for 10％ of C grouptype,Ⅲ accounting for 57％ of C group,typeⅣ accounting for 30 ％ of D group.The levels of Albumin in B group,C group and D group decreased significantly with comparing to A group (P ＜ 0.05).Compared with A group,the levels of BUN and Scr in D group were increased significantly (P ＜ 0.05).The thickness of Glomerular basement membrane in each DN group were increased significantly with the increase of proteinuria(P ＜0.05).The injuries of Renal pathological were also more serious.Conclusion There was a series of changes in the renal pathological and functional of 2TDN patients which were correlative with the process of proteinuria.The pathological classification of DN can increase the diagnosis rate,contributing to the early diagnosis and treatment of DN.