170例糖尿病肾病肾活检分析

目的探讨肾活检对糖尿病肾病(DN)的诊断价值及治疗的指导作用。方法对170例伴有微量白蛋白尿(MAU)或临床蛋白尿(CAU)的2型糖尿病患者(T2DM)进行肾穿刺活检，观察肾活检组织病理与各临床参数之间的关系。结果在170例伴MAU或CAU的DM患者中，DN119例(70．0％)，其中早期系膜增生者22例，典型DN表现者97例。在典型DN表现者中，结节性肾小球硬化47例(39．5％)，弥漫性肾小球硬化50例(42．0％)。DN或DM合并其他肾脏病变51例(30．0％)，其中DN合并IgA肾病13例(25.5％)、间质性肾炎8例(15．7％)、膜增生性肾炎2例(3．9％)，DM合并IgA肾病10例(19．6％)、系膜增生性肾小球肾炎4例(7．8%)、微小病变肾炎4例(7．8％)、间质性肾炎6例(11．8％)、膜性肾病2例(3．9％)、新月体性肾炎2例(3．9％)。结论对临床不能确诊的T2DM蛋白尿患者应提倡做肾活检。

Renal biopsy analysis of 170 diabetic nephropathy in type 2 diabetes

Objective To explore the value of renal biopsy in diagnosis and the management of diabetic nephropathy (DN). Methods Renal biopsy specimens were obtained from 170 DN patients with type 2 diabetics. The clinical parameters and histopathological findings of renal biopsy samples were examined. Results DN alone was seen in 119 patients (70.0%), including 22 with early (mesangial) proliferative DN, 97 with typical DN (47 with nodular glomerulosclerosis, 50 with diffused glomerulosclerosis).Non-diabetice renal disease was found in 51 patients. Among those with DN, 13(25.5%)were diagnosed as IgA nephropathy, 8(15.7%) as interstitial nephritis and 2(3.9%) as (proliferative) glomerulonephritis. Among those with DM, 10(19.6%) were diagnosed as IgA (nephropathy), 4(7.8%) as mesangial proliferative glomerulonephritis, 4(7.8%) as minimal change nephritis, 6(11.8%) as interstitial nephritis, 2(3.9%) as membranous nephropathy and 2(3.9%) as crescentic glomerulonephritis. Conclusions It is encouraged that renal biopsy should be done in the T2DM whose DN can not be diagnosed.