论文部分内容阅读
目的 探讨肾活检对糖尿病肾病(DN)的诊断价值及治疗的指导作用。 方法 对170例伴有微量白蛋白尿(MAU)或临床蛋白尿(CAU)的 2 型糖尿病患者(T2DM)进行肾穿刺活检,观察肾活检组织病理与各临床参数之间的关系。 结果 在170例伴MAU或CAU的DM患者中,DN 119例(70.0%),其中早期系膜增生者22例,典型DN表现者97例。在典型 DN表现者中,结节性肾小球硬化47例(39.5%),弥漫性肾小球硬化 50 例(42 0%)。DN或 DM合并其他肾脏病变 51例(30 0%),其中DN合并 IgA肾病 13 例(25.5%)、间质性肾炎 8 例(15.7%)、膜增生性肾炎 2 例(3 9%),DM合并 IgA肾病10例(19 6%)、系膜增生性肾小球肾炎4例(7.8%)、微小病变肾炎 4 例(7.8%)、间质性肾炎6例(11.8%)、膜性肾病2例(3.9%)、新月体性肾炎2例(3.9%)。 结论 对临床不能确诊的T2DM蛋白尿患者应提倡做肾活检。
Objective To investigate the value of renal biopsy in the diagnosis of diabetic nephropathy (DN) and its guiding effect. Methods A total of 170 patients with type 2 diabetes mellitus (T2DM) with microalbuminuria (MAU) or clinical proteinuria (CAU) underwent renal biopsy to observe the relationship between renal biopsy histopathology and clinical parameters. Results Among the 170 DM patients with MAU or CAU, 119 were DN (70.0%), including 22 cases of early mesangial proliferation and 97 cases of typical DN. Of the typical DN performers, nodular glomerulosclerosis in 47 cases (39.5%), diffuse glomerulosclerosis in 50 cases (42%). Thirty-one patients (30.0%) with DN or DM combined with other nephropathy were enrolled, of whom 13 (25.5%) had DN complicated with IgA nephropathy, 8 (15.7%) had interstitial nephritis, DM combined with IgA nephropathy in 10 cases (19.6%), mesangial proliferative glomerulonephritis in 4 cases (7.8%), minimal change nephritis in 4 cases (7.8%), interstitial nephritis in 6 cases (11.8%), membranous 2 cases of nephropathy (3.9%), 2 cases of crescentic nephritis (3.9%). Conclusions Kidney biopsy should be advocated in patients with clinically unreasonable T2DM proteinuria.