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目的:分析2型糖尿病早期糖尿病性肾病的临床特点。方法:选取21例2型糖尿病早期糖尿病性肾病患者,通过记录患者的年龄,性别,糖尿病病程,发现肾脏疾病的病程,血压,眼底;乙型肝炎病毒学检查,尿常规,尿蛋白定量,血糖,血肌酐,尿素氮,肾脏B超等以及电镜检查,分析其临床特点。结果:所有患者中19例合并高血压,10(47.6%)例呈糖尿病视网膜病改变,21例均有白蛋白尿或微量白蛋白尿,蛋白尿是DKD最常见的临床表现之一,应用24小时尿液收集标本行尿微量白蛋白定量的测定是最敏感的指标。3例患者表现间歇性微量白蛋白尿,而肾脏活检上已表现为糖尿病结节样硬化的病理改变。故临床合并有糖尿病视网膜病变、高血压及微量白蛋白尿三联症对指导临床治疗及判断预后起着极其重要的作用。甚至应及早进行肾活检,通过肾活检病理检查可将DKD和糖尿病伴发的原发性肾小球疾病区分开来。本组病例中可以得出临床表现为肾病综合症伴随肾功能不全(71.4%)的患者,预后最差,5例患者1～3年进入血液透析治疗阶段。表现为非肾病者14例,有6例(42.9%)伴随肾功能不全,这说明在临床上并不是所有的DKD都有低蛋白血症类似肾病综合症表现,部分患者临床表现少量蛋白尿但已伴有明显的肾功能不全,此类患者起病隐匿,对ACEI或AT1RA治疗疗效不佳,肾功能衰竭很快进入终末期,预后不良。结论:糖尿病患者,定期检查24小时尿蛋白定量,若伴有微量白蛋白尿或有间断白蛋白尿,并部分伴随高血压伴或不伴糖尿病性视网膜病变者应积极予以行肾脏病理检查,早期明确病理诊断,及早予以大剂量ACEI或AT1RA治疗,若临床表现为大量蛋白尿,则已是糖尿病性肾病Ⅳ期,预后不良。
Objective: To analyze the clinical features of type 2 diabetic early diabetic nephropathy. Methods: Twenty-one patients with type 2 diabetes mellitus with early diabetic nephropathy were enrolled. The course of renal disease, blood pressure and fundus were recorded by recording the patient’s age, sex, and duration of diabetes. Hepatitis B virus examination, urinalysis, urinary protein, , Serum creatinine, urea nitrogen, kidney B ultrasound and electron microscopy, analysis of its clinical features. Results: Of the 19 patients with hypertension in all 19 patients, 10 (47.6%) had diabetic retinopathy. All had albuminuria or microalbuminuria in 21 patients. Proteinuria was one of the most common clinical manifestations of DKD. 24 Urinary microalbuminuria was the most sensitive indicator of urinary microalbuminuria in urine specimens collected at one hour. Three patients showed intermittent microalbuminuria, and renal biopsy showed pathological changes of diabetic nodular-like sclerosis. Therefore, the clinical combination of diabetic retinopathy, hypertension and microalbuminuria triad to guide the clinical treatment and prognosis plays an extremely important role. Even renal biopsy should be performed as early as possible, distinguishing between primary DKD and primary glomerular disease associated with diabetes through a renal biopsy. This group of patients can be drawn clinical manifestations of nephrotic syndrome with renal insufficiency (71.4%) of the patients with the worst prognosis, 5 patients 1 to 3 years into the hemodialysis treatment stage. 14 cases showed non-renal disease, 6 cases (42.9%) with renal insufficiency, indicating that not all clinically DKD have hypoproteinemia-like nephrotic syndrome, some patients with clinical manifestations of a small amount of proteinuria Has been associated with significant renal insufficiency, occult onset of such patients, poor efficacy of ACEI or AT1RA treatment, renal failure quickly into the terminal phase, the prognosis is poor. Conclusion: Diabetic patients, regular examination of urinary protein in 24 hours quantitative, if accompanied by microalbuminuria or intermittent albuminuria, and some with or without diabetic retinopathy should be actively carried out renal pathological examination, early Clear pathological diagnosis, as soon as large doses of ACEI or AT1RA treatment, if the clinical manifestations of a large number of proteinuria, it is already diabetic nephropathy stage Ⅳ, the prognosis is poor.