本文關(guān)鍵詞： 糖尿病腎病 型糖尿病 腎活檢 組織病理學(xué)　出處：《中國老年學(xué)雜志》2017年08期 　論文類型：期刊論文

【摘要】：目的探討老年2型糖尿病(T2DM)伴單純糖尿病腎病(DN)、非糖尿病腎病(NDRD)和DN合并NDRD的臨床及病理特點。方法回顧性分析住院行腎活檢的70例老年T2DM患者的臨床及病理資料,詳細比較DN、NDRD、DN+NDRD三組的臨床及病理特點,并與同期203例非老年T2DM患者的臨床及病理資料進行對比。結(jié)果按病理分型的3個亞組:DN亞組占25.27%〔(14+55)/273〕,NDRD亞組占63.74%〔(44+130)/273〕,DN+NDRD亞組占10.99%〔(12+18)/273〕。其中,DN亞組老年患者占5.13%,非老年患者占20.15%;NDRD亞組老年患者占16.12%,非老年患者占47.62%;DN+NDRD亞組老年患者占4.39%,非老年患者占6.59%�？傮w上老年組的DM病史、腎衰竭發(fā)生率明顯高于非老年組,而老年組體重指數(shù)(BMI)、腎小球濾過率(e GFR)、血清白蛋白水平明顯低于非老年組(P0.05)。老年組DN亞組的腎衰竭發(fā)生率明顯高于非老年組,而BMI、24 h尿蛋白定量(UP)明顯低于非老年組;老年組的NDRD亞組腎衰竭發(fā)生率明顯高于非老年組,而BMI、e GFR明顯低于非老年組(P0.05);老年組DN+NDRD亞組的腎病綜合征發(fā)病率和24 h-UP明顯高于非老年組。老年組內(nèi)DN亞組的24 h-UP、BMI明顯低于DN+NDRD亞組;NDRD亞組DM病史、24 h-UP明顯低于DN+NDRD亞組。非老年組內(nèi)DN亞組的DM病史、24 h-UP明顯高于NDRD亞組,而BMI、e GFR低于NDRD亞組;非老年組內(nèi)DN亞組的24 h-UP明顯高于DN+NDRD亞組,而血清白蛋白明顯低于DN+NDRD亞組;非老年組內(nèi)NDRD亞組的24 h-UP、血清白蛋白低于DN+NDRD亞組。病理診斷方面,老年組、非老年組及兩組的NDRD亞組中,膜性腎病占的比例都是最大,Ig A腎病次之。在老年組和非老年組的DN+NDRD亞組中,高血壓腎小動脈硬化是最常見的病理類型。結(jié)論老年T2DM中NDRD并不少見,DN、NDRD及DN+NDRD的臨床表現(xiàn)難以鑒別,只有通過腎活檢才能最終明確DN、NDRD和DN+NDRD的診斷。為提高老年T2DM患者腎臟疾病的緩解率和存活率,還需要大型、多中心、隨機的前瞻性研究明確老年T2DM患者的腎臟病變特點。
[Abstract]:Objective to investigate the clinical and pathological features of type 2 diabetes mellitus (T2DM) with simple diabetic nephropathy (DN) and DN with NDRD. Methods the clinical and pathological data of 70 elderly T2DM patients who underwent renal biopsy were retrospectively analyzed. The clinical and pathological features of DN NDRD group were compared in detail. The clinical and pathological data of 203 non-elderly patients with T2DM were compared with that of the same period. Results according to the pathological classification, the three subgroups: DN subgroup: DN subgroup accounted for 25.27555 / 273D subgroup and 63.74743% NDRD subgroup, accounted for 10.9912 1818 / 273C group, of which DN subgroup accounted for 5.13% and non-elderly patients accounted for 5.13%. The percentage of elderly patients, non-elderly patients, non-elderly patients and non-elderly patients were 16.12, 4.39 and 6.59 respectively. The incidence of renal failure in the elderly group was significantly higher than that in the non-elderly group, and the body mass index (BMI), glomerular filtration rate (GFRN) and serum albumin level in the elderly group were significantly lower than those in the non-elderly group (P 0.05), and the incidence of renal failure in the DN subgroup in the elderly group was significantly higher than that in the non-elderly group. The incidence of renal failure in the elderly group was significantly higher than that in the non-elderly group, and the incidence of renal failure in the elderly group was significantly higher than that in the non-elderly group. The incidence of nephrotic syndrome and 24h-UP in DN NDRD subgroup were significantly higher than those in non-elderly group, and 24 h-UP in DN subgroup was significantly lower than that in DN NDRD subgroup. In DN NDRD subgroup, the DM history in DN subgroup was significantly higher than that in NDRD subgroup. The 24 h-UP in DN subgroup was significantly higher than that in DN NDRD subgroup, and the serum albumin level in NDRD subgroup was significantly lower than that in DN NDRD subgroup, and the serum albumin in NDRD subgroup was lower than that in DN NDRD subgroup. The proportion of membranous nephropathy in the elderly group, non-elderly group and NDRD subgroup of both groups was the largest in IgA nephropathy group, and in the DN NDRD subgroup in the elderly group and non-senile group, the proportion of membranous nephropathy was the highest in the elderly group and the non-senile group. Conclusion the clinical manifestations of NDRD and DN NDRD are not uncommon in elderly patients with T2DM. In order to improve the remission rate and survival rate of renal diseases in elderly patients with T2DM, a large, multicenter, randomized prospective study was needed to determine the characteristics of renal lesions in elderly patients with T2DM.
【作者單位】： 吉林大學(xué)第二醫(yī)院腎病內(nèi)科;
【基金】：吉林省科技廳國際合作資助項目(No.20140414030GH)
【分類號】：R587.2;R692.9

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