2型糖尿病合并IgA肾病与糖尿病肾病患者的临床分析

目的：分析2型糖尿病合并IgA肾病与2型糖尿病合并糖尿病肾病患者的临床特点,鉴别诊断要点。方法：回顾分析18例2型糖尿病合并IgA肾病与15例2型糖尿病合并糖尿病肾病患者的临床资料。结果：2型糖尿病合并IgA肾病患者糖尿病病史（10.72±18.66个月）明显短于糖尿病肾病患者（58.73±71.12个月）,P〈0.05。IgA肾病组在肾活检时血肌酐升高的比例（5.56%）明显低于糖尿病肾病组（46.67%）,P〈0.05,伴有血尿的患者（61.11%）明显多于糖尿病肾病组（20.00%）,P〈0.05。IgA肾病组总胆红素、丙氨酸氨基转移酶、血清免疫球蛋白A、血清免疫球蛋白G、血钙明显高于糖尿病肾病组（分别为13.28±4.14μmol.L^-1比9.95±4.87μmol.L^-1、34.22±18.11U.L^-1比19.73±16.04U.L^-1;4.00±2.16g.L^-1比2.11±0.86g.L^-1;12.47±4.76g.L^-1比9.04±2.41g.L^-1和2.37±0.17mmol.L^-1比2.22±0.20mmol.L^-1）。IgA肾病组血尿素氮、血肌酐、50%补体溶血单位、随机尿白蛋白/肌酐比值、24h尿蛋白显著低于糖尿病肾病组分别为5.86±1.59mmol.L^-1比10.76±5.89mmol.L^-1;82.72±23.76μmol.L^-1比185.20±107.19μmol.L^-1;50.51±5.80IU.mL^-1比55.37±6.17IU.mL^-1;959.50±395.00μg.（mgCr）^-1比3193.85±2085.00μg.（mgCr）^-1和2.22±2.13g.（24h）^-1比4.69±2.92g.（24h）^-1]。两组血糖、血脂均无统计学差异。IgA肾病患者荧光眼底血管造影和肌电图检查未见异常,糖尿病肾病组有2例糖尿病视网膜病变和3例糖尿病周围神经病变。结论：2型糖尿病合并IgA肾病的患者尿检异常出现前糖尿病病史大多短于5年,血尿、血清免疫球蛋白A升高多见,尿检异常出现时无糖尿病视网膜病变或周围神经病变。

Clinical Analysis of IgA Nephropathy and Diabetic Nephropathy in Type 2 Diabetes

Objective：To explore clues to IgA nephropathy in type 2 diabetes （2-DM） patients. Methods：Clinical data of 18 IgA nephropathy patients and 15 diabetic nephropathy patients in type 2 diabetes are retrospectively studied. Results： The diabetic history of IgA nephropathy group（10.72 ± 18.66 months） was shorter than that of diabetic nephropathy group（58.73 ± 71.12 months,P〈0.05. At the time of renal biopsy, percent of elevated serumcreatineinIgAnephropathygroup（5.56%） was low er than that in diabetic nephropathy group（46.67%）（P〈0.05）,but percent of hematuria in IgA nephropathy group（61.11%） was higher than that , in diabetic nephropathy group（20.00% , P〈0.05. Total bilirubin, alanine aminotransferase, serum immunoglobulin A, serum immunoglobulin G, serum calcium in IgA nephropathy group were higher than those in diabetic nephropathy group （13. 28 ± 4.14 μmol · L^-1 vs. 9.95±4.87 μmol· L^-1, 34.22±18.11 U· L^-1 vs. 19.73±16.04 U· L^-1, 4.00±2.16 g· L^-1 vs. 2.11 ±0.86 g· L^-1, 12.47±4.76g· L^-1 vs. 9.04±2.41 g· L^-1 and2.37±0.17mmol· L^-1 vs. 2.22±0.20mmol ·L^-1, respective ly）. Serum urea nitrogen, serum creatine, serum chlorine, 50% hemolytic unit of complement, alubumin/creatinine ratio, total urine protein of 24 hours in IgA nephropathy group were lower than those in diabetic nephropathy groupE5.86 ± 1.59 mmol · L^-1 vs. 10.76 ±5.89mmol· L^-1 , 82. 72 ± 23. 76 μmol· L^-1 vs. 185.20± 107.19 μmol· L^-1 ,102. 24± 2. 66 mmol· L^-1 vs. 104.67±2.23 mmol· L^-1 ,50.51 ± 5.80 IU · mL^-1 vs. 55.37 ± 6. 17 IU· mL^-1 ,959.50 ± 395.00 μg· （mg Cr） ^-1 vs. 3193.85 ± 2085.00 μg· （mg Cr） ^-1 and 2.22 ± 2.13 g · （24 h） ^-1 vs. 4.69 ± 2.92 g · （24 h） ^-1 , respectively]. There was no significant difference in blood glucose, serum lipid between two groups. Fundus fluorescein angiography and electromyogram of IgA nephropathy group were normal. There were 2 patients with diabetic retinopathy and 3 patients with diabetic