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目的探究2型糖尿病合并慢性肾病(DCKD)的临床病理特点及其内在的损伤机制。方法回顾分析2型糖尿病合并慢性肾病的临床病理特点,用免疫组化及蛋白免疫印记检测其肾脏组织糖基化终末产物受体(RAGE)的表达量,并与其临床特征作相关性分析。结果 DCKD组病理分型多样,以IgA肾病最多;而单纯糖尿病肾病(DN)组则相对单一。DCKD组病例的发病年龄(46±5)岁、糖尿病病程(39±6)月均低于DN组,两组比较差异有统计学意义(P<0.05)。但DCKD组发生血尿(62.8%)、蛋白尿(51.4%)的比例高,且大多数缺乏典型的糖尿病视网膜病变;其RAGE表达富集上调。结论 2型糖尿病合并慢性肾脏病的临床特征与病程不符,病理分型多样,诊断仍需依靠肾活检;其肾损害与AGEs-RAGE轴密切相关,可为临床治疗提供有用的信息。
Objective To investigate the clinicopathological characteristics and its intrinsic mechanism of type 2 diabetes with chronic kidney disease (DCKD). Methods The clinicopathological features of type 2 diabetes mellitus combined with chronic kidney disease were retrospectively analyzed. The expression of RAGE in renal tissues was detected by immunohistochemistry and Western blotting, and its correlation with clinical features was analyzed. Results The pathological types of DCKD group were diversified, with IgA nephropathy the most, while that of simple diabetic nephropathy (DN) group was relatively single. The age of onset (46 ± 5) years and duration of diabetes (39 ± 6) in DCKD group were all lower than those in DN group, with significant difference between the two groups (P <0.05). However, hematuria (62.8%) and proteinuria (51.4%) occurred in DCKD group, and most of them lacked typical diabetic retinopathy. RAGE expression was upregulated in DCKD group. Conclusion The clinical features of type 2 diabetes mellitus and chronic kidney disease are not consistent with the course of the disease. The pathological classification is diverse and the diagnosis still depends on the renal biopsy. The renal damage is closely related to the AGEs-RAGE axis, which may provide useful information for clinical treatment.