2型糖尿病合并非糖尿病肾病的临床及病理分析

目的：回顾性分析2型糖尿病合并非糖尿病肾病的临床表现及病理特征。方法：回顾性分析2004年1月～2009年12月临床疑为合并非糖尿病肾病的110例2型糖尿病患者的肾活检资料。根据肾活检结果分为单纯糖尿病肾病（DN）组和糖尿病肾病合并非糖尿病肾病（NDRD）组,并对临床和病理资料进行分析。结果：110例2型糖尿病肾病患者中,50例（45.5%）合并非糖尿病肾病。糖尿病肾病合并非糖尿病肾病组蛋白尿、血尿发生率高于单纯糖尿病肾病组,但糖尿病视网膜病变发生率低于单纯糖尿病肾病组。两组年龄、糖尿病病程、高血压、血肌酐和肾小球滤过率差异无统计学意义。所有合并的非糖尿病肾病中,IgA肾病的比率最高为34%,其他依次为膜性肾病22.0%,系膜增殖性肾小球肾炎14%,HBV相关性肾小球肾炎8.0%,微小病变型肾小球肾炎10%,高血压肾小球硬化4.0%,FSGS4.0%,新月体肾小球肾炎2.0%,狼疮性肾炎2.0%。结论：2型糖尿病肾病合并非糖尿病肾病发生率45.5%,IgA肾病最常见。血尿、蛋白尿同时缺乏糖尿病视网膜病变强烈提示合并非糖尿病肾病。对于临床表现不典型的患者,肾活检是一项排除糖尿病肾脏病变的重要手段。

Clinical Pathological Analysis of Non-diabetic Renal Disease in Patients with Type 2 Diabetes Mellitus

Objective：The purpose of this retrospective study was to evaluate the renal biopsies performed on type 2 diabetic patients for suspicion of non-diabetic renal disease（NDRD）and to correlate the pathological with the clinical findings.Methods：From January 2004 to December 2009,110 people with type 2 diabetes with clinically suspected NDRD underwent renal biopsy.The case records of these patients were retrospectively analyzed.Based on the biopsy findings,patients were divided into two groups：group Ⅰ,isolated diabetic nephropathy（DN）and groupⅡ,NDRD with underlying DN.Clinical and laboratory data were analyzed in relation to the histopathology findings.Results：Of the 110 patients studied,Renal biopsy showed 50 patients（45.5%）had NDRD with underlying DN.GroupⅡ had a significantly higher level of proteinuria and haematuria,but less frequent diabetic retinopathy.There was no significant difference between the two groups in age,duration of diabetes,presence of hypertension,serum creatinine and glomerular filtration rate.IgA nephropathy was the most common,accounting for 34% of group Ⅱ,membranous nephropathy ranked second accounting for 22.0%,followed by mesangial proliferative nephritis 14%.HBV-associated GN 8%,minimal change disease10%,hypertensive nephrosclerosis 4%,FSGS 4%,crescentic GN 2%,lupus glomerulonephritis 2%.Conclusion：The present study showed that IgA nephropathy is the commonest NDRD among diabetics.The absence of retinopathy,especially when associated with nephritic proteinuria and haematuria,strongly predict NDRD superimposed on DN.Renal biopsy should be performed in diabetics when the clinical scenario is atypical.