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目的分析2型糖尿病患者合并不同类型肾脏损伤的临床表现、肾脏病理分型,探讨临床特点和病理类型之间的关系,以指导临床诊治。方法分析1998年12月-2008年12月53例接受肾活检的2型糖尿病患者,其中男38例,女15例,平均52岁,糖尿病病程0～22年,平均5年。分析纳入患者的临床表现、肾脏病理特点和肾脏损伤程度。结果 2型糖尿病合并肾脏损伤以中老年多见,年龄50～74岁,其中糖尿病肾病(DN)34例,44.1%的患者肾脏损害出现在发现糖尿病5年后;非糖尿病肾病(DM+NDRD)16例,81.3%的患者肾脏损害出现在发现糖尿病5年内;糖尿病肾病合并非糖尿病肾病(DN+NDRD)3例,平均糖尿病病程均<5年。2型糖尿病合并肾脏损伤的肾脏病理类型多样,除DN(占64.2%)外,17.0%的患者为膜性肾病,7.5%的患者为系膜增生性肾病。结论 2型糖尿病合并肾损伤以DN为多,亦可出现DM+NDRD或DN+NDRD,通过肾活检明确肾脏病理类型对临床治疗及判断预后有指导意义。
Objective To analyze the clinical manifestations and renal pathological classification of patients with type 2 diabetes mellitus combined with different types of kidney injury and to explore the relationship between clinical features and pathological types in order to guide clinical diagnosis and treatment. Methods Fifty-three patients with type 2 diabetes undergoing renal biopsy from December 1998 to December 2008 were enrolled. Among them, 38 were males and 15 were females, with an average of 52 years. Diabetes duration ranged from 0 to 22 years with an average of 5 years. Analysis of patients included in the clinical manifestations, pathological features of kidney and kidney damage. Results Type 2 diabetes mellitus was more common in middle-aged and elderly patients, aged 50-74 years old. Among them, 34 cases of diabetic nephropathy (DN) and 44.1% of patients suffered kidney damage 5 years after the discovery of diabetes. Non-diabetic nephropathy (DM + NDRD) In 16 cases, 81.3% of the patients had kidney damage within 5 years of finding diabetes; 3 cases of diabetic nephropathy with non-diabetic nephropathy (DN + NDRD), and the mean duration of diabetes was less than 5 years. In type 2 diabetic patients with kidney injury, the pathological types of kidney were diverse. In addition to DN (64.2%), 17.0% had membranous nephropathy and 7.5% had mesangial proliferative nephropathy. Conclusions There is more DN in type 2 diabetic patients with renal injury, and DM + NDRD or DN + NDRD may also occur. It is of guiding significance for clinical treatment and prognosis to confirm the renal pathological type by renal biopsy.