糖尿病合并非糖尿病性肾损害的临床病理分析(1)
[摘要] 目的 分析糖尿病(DM)合并非糖尿病性肾损害(NDRD)患者的临床病理表現。 方法 回顾性分析2016年1月—2018年1月该院收治的98例DM合并NDRD患者的临床资料，分析DM合并NDRD患者的临床病理特点、治疗及预后情况。 结果 DM合并NDRD患者常合并多种NDRD，以肾小球病变为主，包括膜性肾病、系膜增生性肾小球肾炎、IgA肾病、微小病变、局灶节段性硬化等；临床表现：肾炎综合征、血尿、急慢性肾功能不全、蛋白尿、肾病综合征等；与糖尿病肾病的不同特点包括：①血尿明显；②急性肾功能衰竭；③肾功能不全或蛋白尿明显增多时血压正常；④糖尿病病程<5年。结论 DM合并NDRD患者常合并有不用类型肾损伤，与糖尿病肾病有明显区别，通过肾组织活检可以确诊。在控制血糖、血压基础上给予糖皮质激素、细胞毒类药物治疗可以改善患者预后。
[关键词] DM；NDRD；临床病理；治疗；预后
[中图分类号] R587.1 [文献标识码] A [文章编号] 1672-4062(2018)05(a)-0039-02
[Abstract] Objective To analyze the clinical pathological manifestations of diabetes combined with non-diabetic renal damage. Methods 98 cases of patients with DM combined with NDRD admitted and treated in our hospital from January 2016 to January 2018 were selected， and the clinical pathological features， treatment and prognosis of patients with DM combined with NDRD were analyzed. Results The patients with DM and NDRD were combined with multiple NDRD usually， dominated by glomerulopathy， including membranous nephropathy， mesangial proliferative glomerulonephritis， IgA nephropathy， minimal lesion， focal segmental sclerosis， and the clinical performance： nephritis syndrome， hematuria， acute and chronic renal insufficiency， proteinuria， nephrotic syndrome， and different features of diabetic nephropathy included：①obvious hematuria；②acute renal failure；③normal blood pressure at renal Insufficiency or when the albuminuria obviously increased；④diabetes course< 5 years. Conclusion The patients with DM combined with NDRD have different types of renal injuries， which has an obvious difference with the diabetic nephropathy， and it can be confirmed by the renal tissue biopsy， and it can improve the prognosis of patients by using the glucocorticoid and cytotoxic drugs for treatment on the basis of controlling the blood glucose and blood pressure.
[Key words] DM； NDRD； Clinical pathology； Treatment； Prognosis
糖尿病(diabetes mellitus，DM)是临床高发疾病，因胰岛素分泌缺陷或者其生物因素导致血糖明显升高、代谢紊乱[1]。糖尿病肾病是DM患者的常见并发症，随着临床长期研究发现，DM合并有肾损伤患者中约有20%左右的患者为非糖尿病性肾损害(Nondiabetic renal damage，NDRD)。NDRD与糖尿病肾病的临床表现、治疗方法、预后情况有显著差异，了解NDRD临床病理特点对DM患者肾损伤的早期诊治具有重要作用。该文选取2016年1月—2018年1月收治的98例患者为研究对象，就DM合并NDRD患者的临床病理表现进行分析总结，现报道如下。
1 资料与方法
1.1 一般资料
观察对象为该院收治的98例DM合并NDRD患者，其中男58例，女40例；年龄23～76岁，平均年龄(45.3±2.9)岁；糖尿病病程2～16年，平均(7.2±1.2)年。所有患者经血糖测定、肾组织活检、电镜检查、免疫荧光检查确诊。
1.2 方法
糖尿病及其合并症观察指标有血压、血糖、心脏情况、眼底情况、糖耐量试验等；肾损伤观察指标有肾功能指标(β2微球蛋白、血肌酐、24 h尿蛋白定量、肌酐清除率、尿酶)尿沉渣镜检、血清白蛋白、血脂、尿渗透浓度、肾脏体积等；同时观察患者血及尿免疫固定电泳、乙型肝炎病毒学指标、补体C1、免疫球蛋白情况。, 百拇医药(王岩峰 赵欣 杨勇)
[关键词] DM；NDRD；临床病理；治疗；预后
[中图分类号] R587.1 [文献标识码] A [文章编号] 1672-4062(2018)05(a)-0039-02
[Abstract] Objective To analyze the clinical pathological manifestations of diabetes combined with non-diabetic renal damage. Methods 98 cases of patients with DM combined with NDRD admitted and treated in our hospital from January 2016 to January 2018 were selected， and the clinical pathological features， treatment and prognosis of patients with DM combined with NDRD were analyzed. Results The patients with DM and NDRD were combined with multiple NDRD usually， dominated by glomerulopathy， including membranous nephropathy， mesangial proliferative glomerulonephritis， IgA nephropathy， minimal lesion， focal segmental sclerosis， and the clinical performance： nephritis syndrome， hematuria， acute and chronic renal insufficiency， proteinuria， nephrotic syndrome， and different features of diabetic nephropathy included：①obvious hematuria；②acute renal failure；③normal blood pressure at renal Insufficiency or when the albuminuria obviously increased；④diabetes course< 5 years. Conclusion The patients with DM combined with NDRD have different types of renal injuries， which has an obvious difference with the diabetic nephropathy， and it can be confirmed by the renal tissue biopsy， and it can improve the prognosis of patients by using the glucocorticoid and cytotoxic drugs for treatment on the basis of controlling the blood glucose and blood pressure.
[Key words] DM； NDRD； Clinical pathology； Treatment； Prognosis
糖尿病(diabetes mellitus，DM)是临床高发疾病，因胰岛素分泌缺陷或者其生物因素导致血糖明显升高、代谢紊乱[1]。糖尿病肾病是DM患者的常见并发症，随着临床长期研究发现，DM合并有肾损伤患者中约有20%左右的患者为非糖尿病性肾损害(Nondiabetic renal damage，NDRD)。NDRD与糖尿病肾病的临床表现、治疗方法、预后情况有显著差异，了解NDRD临床病理特点对DM患者肾损伤的早期诊治具有重要作用。该文选取2016年1月—2018年1月收治的98例患者为研究对象，就DM合并NDRD患者的临床病理表现进行分析总结，现报道如下。
1 资料与方法
1.1 一般资料
观察对象为该院收治的98例DM合并NDRD患者，其中男58例，女40例；年龄23～76岁，平均年龄(45.3±2.9)岁；糖尿病病程2～16年，平均(7.2±1.2)年。所有患者经血糖测定、肾组织活检、电镜检查、免疫荧光检查确诊。
1.2 方法
糖尿病及其合并症观察指标有血压、血糖、心脏情况、眼底情况、糖耐量试验等；肾损伤观察指标有肾功能指标(β2微球蛋白、血肌酐、24 h尿蛋白定量、肌酐清除率、尿酶)尿沉渣镜检、血清白蛋白、血脂、尿渗透浓度、肾脏体积等；同时观察患者血及尿免疫固定电泳、乙型肝炎病毒学指标、补体C1、免疫球蛋白情况。, 百拇医药(王岩峰 赵欣 杨勇)