2型糖尿病对原发性膜性肾病临床转归的影响

目的 探讨2型糖尿病(T2DM)对原发性膜性肾病(PMN)临床结局的影响。方法 回顾性分析行肾脏穿刺活检术确诊PMN患者的相关临床资料。依据患者既往病史及入院血糖水平分为PMN合并T2DM组和PMN组。比较2组患者基线资料及病理特征。采用Kaplan-Meier法比较2组患者的累积完全缓解率和累积肾功能恶化率。采用Cox回归分析影响PMN合并T2DM组未完全缓解的危险因素。结果 共246例纳入研究中，PMN合并T2DM组(61例)的血糖、血尿酸、低密度脂蛋白胆固醇较PMN组(185例)升高(均P<0.05),24 h尿蛋白定量较PMN组降低(P<0.05)。病理资料显示，PMN合并T2DM组的Ⅲ+Ⅳ期比例较高(P<0.05)。Kaplan-Meier曲线显示PMN合并T2DM组累积完全缓解率较低(Log-rank χ²=4.391,P<0.05)；肾功能恶化率比较差异无统计学意义(Log-rank χ²=0.899,P>0.05)。Cox回归分析结果显示，合并T2DM(HR=1.792,95%CI:1.166～2...

Effect of type 2 diabetes mellitus on the clinical outcome of primary membranous nephropathy

Objective To investigate the effect of type 2 diabetes mellitus (T2DM) on the clinical outcome of primary membranous nephropathy (PMN). Methods The clinical data of patients with PMN diagnosed by renal biopsy in our hospital from November 2018 to June 2021 were retrospectively analyzed. Patients were divided into the PMN+T2DM group and the PMN group according to their past medical history and blood glucose level at admission. The baseline data and pathological features were compared between the two groups. Kaplan-Meier method was used to compare the cumulative complete response rate and cumulative deterioration of renal function between the two groups. Cox regression analysis was used to analyze the risk factors of incomplete response in patients with PMN complicated with T2DM. Results A total of 246 patients were included in this study. There were higher levels of blood glucose, uric acid and low density lipoprotein cholesterin in the PMN +T2DM group (n=61) than those of the PMN group (n=61, P<0.05),and there was lower 24-hour urinary protein level in the PMN +T2DM group (P<0.05). The pathological data showed that the proportion of stage Ⅲ+Ⅳ was higher in the PMN +T2DM group (P<0.05). Kaplan-Meier survival curve showed that there was a lower cumulative complete response rate of cumulative urinary protein in the PMN+T2DM group (Log-rank χ²=4.391, P<0.05). There was no significant difference in renal function deterioration (Log-rank χ²=0.899, P>0.05). Cox regression analysis showed that PMN combined T2DM (HR=1.792, 95%CI:1.166-2.753, P=0.008),and 24-hour proteinuria (HR=1.002, 95%CI: 1.000-1.003, P=0.013) were independent risk factors affecting incomplete remission in patients with PMN. Conclusion Although T2DM has no special significance for the risk of renal deterioration, it is of certain value in the evaluation of clinical outcome of such patients.