本文關(guān)鍵詞：糖尿病腎病微量白蛋白尿患者腎臟組織損傷及病情變化的研究　出處：《腎臟病與透析腎移植雜志》2015年03期 　論文類(lèi)型：期刊論文

  更多相關(guān)文章： 糖尿病腎病 微量白蛋白尿 腎組織病理 腎小球?yàn)V過(guò)率 危險(xiǎn)因素

【摘要】：目的:觀察影響2型糖尿病腎病(DN)患者尿微量白蛋白(MAU)進(jìn)展和緩解的臨床與病理因素,并分析其對(duì)腎小球?yàn)V過(guò)率(GFR)下降的影響。方法:納入尿白蛋白定量30~300 mg/24h,血清肌酐≤109.62μmol/L,并愿意接受腎活檢的2型DN患者61例。記錄患者一般情況(基線年齡、糖尿病病程等)、臨床指標(biāo)(e GFR、血脂、血糖、尿白蛋白定量等)及病理指標(biāo)(腎小球體積、系膜區(qū)面積百分比、基膜厚度、足細(xì)胞足突寬度等)。結(jié)果:61例患者中失訪7例,MAU進(jìn)展組22例(40.74%),MAU穩(wěn)定組25例(46.30%),MAU轉(zhuǎn)陰組7例(12.96%)。MAU轉(zhuǎn)陰組患者基線尿白蛋白定量顯著低于穩(wěn)定組和進(jìn)展組[(103.05±53.88)mg/24h vs(139.58±76.88)mg/24h vs(192.58±97.64)mg/24h,P=0.025],高密度脂蛋白水平顯著高于穩(wěn)定組和進(jìn)展組[(1.38±0.34)mmol/L vs(0.94±0.23)mmol/L vs(1.04±0.37)mmol/L,P=0.006],足細(xì)胞裂孔膜分布密度顯著高于穩(wěn)定組和進(jìn)展組[(1.01±0.21)個(gè)/μm vs(0.78±0.21)個(gè)/μm vs(0.58±0.30)個(gè)/μm,P=0.003]。多因素COX回歸分析,顯示足細(xì)胞裂孔膜分布密度(HR=0.029,P0.001)和腎小球體積(HR=0.513,P=0.018)是MAU進(jìn)展的獨(dú)立影響因素;糖尿病病程(HR=0.925,P=0.012)、血尿酸(HR=1.012,P=0.034)、總膽固醇(HR=4.235,P=0.021)、ACEI/ARB使用(HR=311.451,P=0.006)是MAU轉(zhuǎn)陰/緩解的獨(dú)立影響因素。多因素Logistic回歸分析顯示,基線e GFR(HR=0.853,P=0.010)、血尿酸(HR=1.019,P=0.016)是e GFR下降的獨(dú)立危險(xiǎn)因素。結(jié)論:臨床表現(xiàn)MAU的2型DN患者基線臨床病理指標(biāo)能夠預(yù)測(cè)MAU進(jìn)展與緩解,基線e GFR和血尿酸能夠預(yù)測(cè)e GFR下降。
[Abstract]:Objective: To observe the clinical and pathological factors affecting the progression and remission of urinary microalbumin (MAU) in patients with type 2 diabetic nephropathy (DN), and to analyze their effects on the decline of glomerular filtration rate (GFR). Methods: a total of 30~300 mg/24h urinary albumin, serum creatinine is less than 109.62 mol/L, and 61 to type 2 DN patients received renal biopsy cases. The general condition of patients (baseline age, diabetes duration, etc.), clinical indicators (E GFR, blood lipids, blood sugar, urinary albumin quantitation, etc.) and pathological indicators (glomerular volume, percentage of mesangial area, basement membrane thickness, podocyte width of podocyte) were recorded. Results: 7 cases were lost in 61 cases, 22 cases in MAU progressive group (40.74%), 25 cases in MAU stable group (46.30%), 7 cases in MAU conversion group (12.96%). MAU negative patients baseline urinary albumin excretion was significantly lower than that of the stable group and progressive group [(103.05 + 53.88) mg/24h vs (139.58 + 76.88) mg/24h vs (192.58 + 97.64) mg/24h, P=0.025], high density lipoprotein level was significantly higher than that of stable group and progressive group [(1.38 + 0.34) mmol/L vs (0.94 + 0.23) mmol/L vs (1.04 + 0.37) mmol/L, P=0.006], podocyte slit diaphragm density was significantly higher than that of stable group and progressive group [(1.01 + 0.21) / M vs (0.78 + 0.21) / M vs (0.58 + 0.30) / m, P=0.003]. Multivariate COX regression analysis showed that podocyte slit diaphragm density (HR=0.029, P0.001) and glomerular volume (HR=0.513, P=0.018) were independent factors affecting the development of MAU; the duration of diabetes (HR=0.925, P=0.012), blood uric acid (HR=1.012, P=0.034), total cholesterol (HR=4.235, P=0.021), ACEI/ARB (HR=311.451 P=0.006) is MAU negative / independent effect mitigating factor. Multiple factor Logistic regression analysis showed that the baseline e GFR (HR=0.853, P=0.010), and blood uric acid (HR=1.019, P=0.016) were independent risk factors for the decrease of E GFR. Conclusion: the baseline clinicopathological indicators of type 2 DN patients with clinical manifestation of MAU can predict MAU progression and remission. Baseline e GFR and blood uric acid can predict a decline in E GFR.
【作者單位】： 南京大學(xué)醫(yī)學(xué)院附屬金陵醫(yī)院(南京軍區(qū)南京總醫(yī)院)腎臟科
【基金】：國(guó)家科技支撐計(jì)劃課題(2013BAI09B04,2015BAI12B05) 江蘇省臨床醫(yī)學(xué)中心項(xiàng)目(BL2012007)
【分類(lèi)號(hào)】：R587.2;R692
【正文快照】： 糖尿病腎病(DN)是2型糖尿病的嚴(yán)重并發(fā)癥,也是導(dǎo)致終末期腎病的主要病因[1,2]。尿白蛋白排泄增加是DN的早期臨床表現(xiàn),尿白蛋白增加不僅與腎小球?yàn)V過(guò)率(GFR)快速下降密切相關(guān),而且是DN患者心血管并發(fā)癥的重要風(fēng)險(xiǎn)因素[3]。長(zhǎng)期以來(lái),DN被認(rèn)為是一種不可逆的進(jìn)展性疾病,尿微量白

【共引文獻(xiàn)】

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