本文選題：糖尿病 + 微量白蛋白尿��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:分析比較2型糖尿病腎臟疾病與2型糖尿病合并非糖尿病腎病的臨床及病理特征,探索2型糖尿病合并非糖尿病腎病臨床預(yù)測因子及其預(yù)測價(jià)值。方法:回顧性分析2010年11月至2016年10月于吉林大學(xué)第一醫(yī)院住院接受腎穿刺活檢術(shù),且臨床診斷為2型糖尿病伴有顯性白蛋白尿的146例患者的臨床和病理資料,所有對(duì)象符合入選標(biāo)準(zhǔn),且具有完整的一般臨床資料及實(shí)驗(yàn)室指標(biāo)。按病理資料將患者分為典型糖尿病腎小球病組(DG組,n=30例),不典型糖尿病相關(guān)腎病組(ADRD組,n=6例),非糖尿病腎病組(NDRD組,n=110),分析比較典型糖尿病腎小球病組、不典型糖尿病相關(guān)腎病組和非糖尿病腎病組之間的臨床及病理特點(diǎn)。探討2型糖尿病合并非糖尿病腎病臨床預(yù)測因子,同時(shí)通過計(jì)算ROC曲線下面積、計(jì)算靈敏度、特異度、總符合率、陽性預(yù)測值和陰性預(yù)測值對(duì)鑒別NDRD的臨床因子預(yù)測價(jià)值進(jìn)行評(píng)估。采用SPSS22.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1、我院2010年11月至2016年10月行腎穿刺活檢術(shù),且臨床診斷為2型糖尿病伴有顯性白蛋白尿的146例患者,非糖尿病腎病在2型糖尿病腎損害中占比75.3%,病理類型以膜性腎病最多,臨床表現(xiàn)以腎病綜合征為主。2、典型糖尿病腎小球病組較非糖尿病腎病組糖尿病病程長,糖尿病視網(wǎng)膜病變發(fā)生率多、分期高,收縮壓、平均動(dòng)脈壓高,eGFR低,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。不典型糖尿病相關(guān)腎病組和非糖尿病腎病組相比較,糖尿病視網(wǎng)膜病變發(fā)生率多、分期高,血清Cys-C水平低,高血壓發(fā)生率小,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。3、2型糖尿病腎病患者糖尿病視網(wǎng)膜病變陽性率67.7%,非糖尿病腎病組中陽性率為22.8%,非糖尿病腎病組以非增殖期糖尿病視網(wǎng)膜病變?yōu)橹饕R床表現(xiàn)。4、糖尿病病程5年、不伴糖尿病視網(wǎng)膜病變、血尿、eGFR≥60 ml/min/1.73m~2對(duì)鑒別診斷非糖尿病腎病有預(yù)測價(jià)值,其中糖尿病病程5年預(yù)測價(jià)值最大。結(jié)論:1、典型糖尿病腎小球病和不典型糖尿病相關(guān)腎病組較非糖尿病腎病組糖尿病病程長,糖尿病視網(wǎng)膜病變發(fā)生率多、分期高。典型糖尿病腎小球病較非糖尿病腎病組收縮壓、平均動(dòng)脈壓高,eGFR低。不典型糖尿病相關(guān)腎病組與非糖尿病腎病組相比較,高血壓發(fā)生率小。2、非糖尿病腎病在2型糖尿病腎損害患者中占比較大(75.3%),病理類型以膜性腎病最多,臨床表現(xiàn)以腎病綜合征為主。3、糖尿病病程5年、不伴糖尿病視網(wǎng)膜病變、血尿、eGFR≥60ml/min/1.73m~2對(duì)鑒別診斷非糖尿病腎病有預(yù)測價(jià)值,其中糖尿病病程5年預(yù)測價(jià)值最大。
[Abstract]:Objective: to compare the clinical and pathological features of type 2 diabetic nephropathy and type 2 diabetes mellitus with non-diabetic nephropathy, and to explore the clinical predictive factors and their predictive value of type 2 diabetes mellitus with non-diabetic nephropathy. Methods: the clinical and pathological data of 146 patients with type 2 diabetes mellitus with dominant albuminuria were analyzed retrospectively from November 2010 to October 2016 in the first Hospital of Jilin University. All subjects met the selection criteria and had complete general clinical data and laboratory indicators. According to the pathological data, the patients were divided into typical diabetic glomerular disease group (DG) group (n = 30), atypical diabetic associated nephropathy group (n = 6), ADRD group (n = 6) and NDRD group (n = 11010). Clinical and pathological features between atypical diabetic nephropathy and non-diabetic nephropathy. To investigate the clinical predictive factors of type 2 diabetes mellitus complicated with non-diabetic nephropathy, and to calculate the area under ROC curve, the sensitivity, specificity, and the total coincidence rate. Positive predictive value and negative predictive value were used to evaluate the predictive value of clinical factors in differentiating NDRD. SPSS22.0 software was used for statistical analysis. Results from November 2010 to October 2016, we performed renal biopsy in 146 patients with type 2 diabetes mellitus with dominant albuminuria. Non-diabetic nephropathy accounted for 75.3% of renal damage in type 2 diabetes mellitus. The most pathological types were membranous nephropathy, and the clinical manifestations were mainly nephrotic syndrome. The course of diabetes in typical diabetic glomerulonephritis group was longer than that in non-diabetic nephropathy group. The incidence of diabetic retinopathy was high, the stage was high, the systolic pressure was high, the mean arterial pressure was high and eGFR was low, the difference was statistically significant (P 0.05). Compared with the non-diabetic nephropathy group, the incidence of diabetic retinopathy was higher, the level of serum Cys-C was low, and the incidence of hypertension was lower in atypical diabetic nephropathy group. The positive rate of diabetic retinopathy in type 2 diabetic nephropathy patients was 67.7%, the positive rate in non-diabetic nephropathy group was 22.8. the main clinical manifestation of non-proliferative diabetic retinopathy group was non-proliferative diabetic retinopathy. (4) the duration of diabetes is 5 years, Without diabetic retinopathy, hematuria eGFR 鈮，

本文編號(hào)：1900281