2型糖尿病患者合并IgA肾病的临床病理分析

目的：了解2型糖尿病(DM)合并IgA肾病的临床病理特点。方法：总结分析13例DM合并IgA肾病的临床资料、病理改变及治疗反应。结果：DM可以合并IgA肾病,在我院糖尿病合并非糖尿病性肾损害(NDRD)中占46．3％。这些患者具有不同于糖尿病肾病的特点：①糖尿病病程一般短于5年;②都有不同程度的血尿;③高血压普遍存在;④组织学病变符合IgA肾病的病理改变,但血管病变较单纯IgA肾病患者严重。⑤表现肾病综合征但病理改变轻微的患者经糖皮质激素治疗后可完全缓解。结论：DM合并肾脏损害不等于全部都是糖尿病肾病,DM合并NDRD病例中IgA肾病常见,肾脏损害以IgA肾病为主,肾血管病变严重。临床表现肾病综合征的患者在充分考虑患者的临床特点、病理改变、严格控制血糖及血压的情况下,糖皮质激素或糖皮质激素联合细胞毒药物治疗是安全有效的,可以改善患者预后。

IgA nephropathy in patients with type 2 diabetes mellitus

objective:To learn the clinical and pathological characteristics of IgA nephropathy in patients with type 2 diabetic nephropathy.Methods:A total of 13 type 2 diabetic patients who had IgA nephropathy were studied retrospectively. The clinical and pathological features, the response to treatment were well observed. Results:diabetes patients combined with IgA nephropathy complicated with diabetes account for 46.3% of all non-diabetic renal disease(NDRD)in our hospital. Theses patients have different clinical features compared with diabetic nephropathy: 1.the courses of diabetes is less than 5 years; 2.certain degrees of hematuria; 3.hypertension is common; 4.tissue pathological changes are identical to IgA nephropathy, but the injury of vessels are severer than pure IgA nephropathy; 5.The patients of nephropathy syndrome with mild pathological changes are well responsible to corticosteroid. Conclusion:The renal diseases in diabetic patients are not all diabetic nephropathy, the most frequent disease entities are IgA nephropathy. The renal injury is due to IgA nephropathy, the vessel changes are severer. When clinical characters, pathological changes were considered completely and glycemia and hypertension were controlled strictly, the administration of corticosteroid or corticosteroid combined with cytotoxic drugs in nephropathy syndrome patients are safe and effective, the prognosis can be improved.