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目的探讨尿红细胞形态检测对糖尿病肾病(DN)和糖尿病合并IgA肾病鉴别诊断的影响。方法回顾性分析2012年2月至2014年2月沈阳市第一人民医院肾内科住院的142例患者资料,按疾病不同分为DN组76例和糖尿病合并IgA肾病患者66例作为IgA组。比较两组患者病程、年龄、24 h平均尿蛋白含量、血尿患者例数、尿红细胞平均计数、尿变形红细胞数量百分比≥50%的患者例数及尿棘形红细胞或小型红细胞≥5%的患者例数。结果 DN组患者年龄及病程均显著大于IgA组,24 h平均尿蛋白含量低于IgA组,差异有统计学意义(P<0.05)。DN组患者血尿发生率、血尿中尿红细胞平均计数、血尿中变形红细胞≥50%患者发生率及血尿中棘形红细胞或小型红细胞≥5%患者发生率均显著低于IgA组,差异有统计学意义(P<0.05)。结论 2型糖尿病患者病程短、合并蛋白尿、尿变形红细胞数量百分比≥50%或尿棘形红细胞或小型红细胞≥5%时,应警惕糖尿病合并IgA肾病的可能,需做病理检查进一步诊断。
Objective To investigate the effect of urine red blood cell morphometric examination on the differential diagnosis of diabetic nephropathy (DN) and diabetes complicated with IgA nephropathy. Methods A retrospective analysis of 142 patients admitted to the Department of Nephrology, First People’s Hospital of Shenyang from February 2012 to February 2014 was divided into two groups according to the disease: 76 cases in DN group and 66 cases in diabetic group with IgA nephropathy as IgA group. The duration of disease, age, average proteinuria at 24 h, number of patients with hematuria, average number of urinary erythrocytes, number of patients with urinary erythrocytes≥50% and patients with ≥5% of urine orbital red cells Number of cases. Results The age and course of DN patients were significantly higher than those of IgA group, and the average urinary protein in 24h group was lower than that in IgA group (P <0.05). The incidence of hematuria in DN group, the mean count of urinary erythrocytes in hematuria, the incidence of hematopoietic erythrocytes≥50% and the incidence of hematuria of spiny erythrocytes or erythrocyte≥5% were significantly lower than those in IgA group Significance (P <0.05). Conclusions Patients with type 2 diabetes mellitus should be alert to the possibility of diabetes complicated with IgA nephropathy when the course of disease is short, the combined percentage of proteinuria and urinary variant erythrocytes is over 50%, or the urinary orbital erythrocytes is over 5%. Pathological examination should be done for further diagnosis.