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目的分析老年糖尿病肾病(diabetic nephropathy,DN)患者的临床、病理特征及预后情况。方法回顾性分析2005年3月至2017年3月在中日友好医院肾内科行肾穿刺活检病理诊断为DN且临床资料完整的25例老年患者,同时分析随访6~125个月的15例患者的预后情况。肾脏结局事件定义为肌酐倍增、需要维持性肾脏替代治疗、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)<15ml·min~(-1)·(1.73m~2)~(-1)或死亡。结果依据2010年美国肾脏病学会杂志发表的DN病理分型标准进行分型,25例老年DN患者中Ⅰ型1例(4%),Ⅱa型2例(8%),Ⅱb型6例(24%),Ⅲ型16例(64%),Ⅳ型0例。Ⅲ型与Ⅰ型+Ⅱa型患者相比,eGFR明显偏低(P<0.05);Ⅱb型与Ⅰ型+Ⅱa型患者相比,eGFR明显偏低(P<0.05)。Ⅱb型与Ⅲ型患者eGFR相比,无统计学差异(P>0.05);Ⅲ型患者血红蛋白明显低于Ⅱb型患者(P<0.05)。15例老年DN患者随访超过6个月,8例发生肾脏结局事件,其中2例死亡,4例因进展为终末期肾病接受维持性肾脏替代治疗,2例仅发生肌酐倍增但尚未发生终末期肾病。老年DN患者肾功能稳定的平均时间为35(23,47)个月,其中1、2、4年肾脏无事件累积生存率分别为84.8%、58.2%、31.1%。年龄、蛋白尿、血压、心脑血管疾病和他汀类药物与老年DN患者肾功能进展密切相关。结论老年DN患者肾功能进展较快,控制蛋白尿、血压和心脑血管疾病的发生是治疗的关键。
Objective To analyze the clinical, pathological features and prognosis of elderly diabetic nephropathy (DN). Methods A retrospective analysis of 25 elderly patients with pathological diagnosis of DN and complete clinical data at the Department of Nephrology, Renmin Hospital of China-Japan Friendship Hospital from March 2005 to March 2017 was performed. At the same time, 15 patients with follow-up of 6 to 125 months The prognosis. Renal outcome was defined as creatinine doubling and required maintenance renal replacement therapy. Estimated glomerular filtration rate (eGFR) was <15 ml · min -1 · 1.73 m -2 · -1 ) Or died. The results were based on the criteria of DN pathological classification published by the American Society of Nephrology in 2010. One case (4%) of type I and two cases of type IIa (8%) and six cases of type IIb (24 %), Type Ⅲ 16 cases (64%), type Ⅳ 0 cases. EGFR was significantly lower in type Ⅲ than in type Ⅰ and type Ⅱa (P <0.05); eGFR was significantly lower in type Ⅱb compared with type Ⅰ and type Ⅱa (P <0.05). There was no significant difference (P> 0.05) between type IIb and type III eGFR patients; type III patients hemoglobin was significantly lower than type IIb patients (P <0.05). Fifteen elderly patients with DN were followed up for more than 6 months. Eight patients had a renal outcome event, two of whom died, four had maintenance renal replacement because of progression to end-stage renal disease, two had creatinine doubling but had not developed end-stage renal disease . The mean time to stable renal function in elderly patients with DN was 35 (23,47) months, of which the cumulative event-free survival rates at 1, 2 and 4 years were 84.8%, 58.2% and 31.1%, respectively. Age, proteinuria, blood pressure, cardiovascular and cerebrovascular diseases and statins are closely related to the progression of renal function in elderly patients with DN. Conclusion The renal function of elderly patients with DN progressed rapidly, and the control of proteinuria, blood pressure and cardiovascular and cerebrovascular diseases is the key to treatment.