西藏地区糖尿病肾病临床特点分析

目的 分析西藏地区2型糖尿病肾病(DN)的临床特点。 方法 回顾分析2001年5月至2006年10月间在我科住院的306例2型糖尿病（DM）患者的临床资料。 结果 306例DM患者包括151例DN和155例非DN患者，根据尿白蛋白及Scr水平，DN组患者再分为微量白蛋白尿组、临床蛋白尿组和肾功能不全组。DN组尿微量白蛋白、Scr和血、尿β2微球蛋白(MG)均较非DN组显著增高（均P < 0.01）；且尿微量白蛋白与收缩压、血β2-MG呈正相关（r = 0.187， P < 0.05； r = 0.297， P < 0.01），而与GFR呈负相关（r = －0.287，P < 0.01）。DN组高血压发生率高（60.27％），血压显著高于非DN组（P < 0.01），且以收缩压更显著。DN组发生尿毒症者14例（9.27％），死亡8例（5.30％），其中5例死于尿毒症；并发糖尿病视网膜病变20例(13.25%)；发生心脑血管意外者6例(3.97%)。 结论 西藏地区2型糖尿病肾病早期即有明显的蛋白尿、血压及血、尿β2-MG增高，后期GFR急剧下降且并发症多而严重。

Analysis of clinical characteristics in patients with type 2 diabetic nephropathy in Tibet area

Objective To analyze the clinical characteristics of patients with type 2 diabetic nephropathy(DN) in Tibet area. Method Clinical data of 306 patients with type 2 diabetes mellitus (DM) in our hospital from may 2001 to october 2006 were retrospectively analyzed. Results Above 306 patients included 151 cases of DN and 155 cases of non-DN ,then the DN patients were divided into microalbuminuria group (n=30), clinical albuminuria group (n=84) and renal insufficiency group (n=37) by the urinary albumin level. As compared to non-DN group, urinary albumin, Scr, β2 microglobulin(MG) increased significantly in DN group（P<0.01）. Urinary albumin was positively correlated with both systolic pressure and blood β2 -MG（r=0.187, P<0.05; r=0.297, P<0.01）, but negatively correlated to glomerular filtration rate(GFR)（r=－0.287, P<0.01）. Patients in DN group had higher incidence of hypertension (60.27％）and higher blood pressure compared with non-DN patients（P<0.01）. In DN patients, 14 cases（9.27%） were suffered from uremia; 8 cases（5.30％） were dead among whom 5 died of uremia; 20 patients (13.25%) were complicated with diabetic retinopathy and 6 (3.97%) with cardiocerebrovascular diseases. Conclusions Significant increment of urinary albumin, blood pressure and β2-MG of blood and urine can be found in early stage of type 2 DN patients in Tibet area, meanwhile the GFR decreases obviously and complications are quite common and severe in late stage of DN.