黃琳 臧宇婷 于暢 王曉忠

糖尿病腎病合并IgA腎病與糖尿病腎病繼發(fā)腎病綜合征患者臨床特征及并發(fā)癥比較

黃琳 臧宇婷 于暢 王曉忠

目的觀察2型糖尿病腎病合并免疫球蛋白A型(IgA)腎病患者與糖尿病腎病繼發(fā)腎病綜合征患者的臨床特征及并發(fā)癥。方法25例經(jīng)臨床和病理確診的2型糖尿病腎病合并IgA腎病患者,將其設(shè)置為觀察組；26例經(jīng)臨床和病理確診為2型糖尿病腎病繼發(fā)腎病綜合征并排除原發(fā)性腎病綜合征患者, 將其設(shè)置為對(duì)照組。比較兩組臨床特征及并發(fā)癥。結(jié)果觀察組糖尿病病程短于對(duì)照組患者,差異有統(tǒng)計(jì)學(xué)意義(P<0.05), 觀察組64%患者尿蛋白定量<1.0 g/24 h, 13%患者≥3.5 g/24 h, 而對(duì)照組90%患者尿蛋白定量≥3.5 g/24 h, 組間比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。觀察組患者的高血壓、視網(wǎng)膜并發(fā)癥發(fā)生率分別64.0%, 24.0%, 均低于對(duì)照患者, 差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論2型糖尿病腎病合并IgA腎病患者糖尿病病程明顯短于糖尿病腎病繼發(fā)腎病綜合征患者, 蛋白尿較低, 高血壓、糖尿病視網(wǎng)膜病變發(fā)生率較低。

糖尿病腎病(DN)是糖尿病最常見(jiàn)的慢性并發(fā)癥［1］。目前DN是美國(guó)和歐洲最常見(jiàn)的終末期腎臟疾病病因。其中約10%的DN患者繼發(fā)腎病綜合征并有腎病綜合征的典型臨床表現(xiàn)［2］。IgA腎病(IgAN) 在我國(guó)是常見(jiàn)的慢性腎小球疾病, 有多種臨床表現(xiàn)形式, 不同的臨床表現(xiàn)形式預(yù)后及并發(fā)癥均不同。本研究主要研究DN合并IgA腎病與DN繼發(fā)腎病綜合征的臨床表現(xiàn)與并發(fā)癥的比較, 幫助提高對(duì)糖尿病患者腎臟損害的認(rèn)識(shí), 改善糖尿病腎病綜合征及DN合并IgA腎病患者的診斷和治療水平, 現(xiàn)報(bào)告如下。

1 資料與方法

1.1 一般資料 選取本院經(jīng)臨床和病理確診的2型DN合并IgA腎病患者25例, 將其設(shè)置為觀察組；26例經(jīng)臨床和病理確診為2型DN繼發(fā)腎病綜合征并排除原發(fā)性腎病綜合征患者, 將其設(shè)置為對(duì)照組, 病理類型均為膜性腎病。觀察組男17例, 女8例, 平均年齡(46.7±12.5)歲；對(duì)照組男15例,女11例, 平均年齡(48.6±13.1)歲。兩組患者性別、年齡比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05), 具有可比性。

1.2 方法 主要以患者的臨床資料、病理特征為依據(jù), 觀察糖尿病自然病程, 尿蛋白定量, 合并高血壓、視網(wǎng)膜病變發(fā)生率, 所有患者均經(jīng)過(guò)腎活檢。

1.3 統(tǒng)計(jì)學(xué)方法 采用SPSS19.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(±s)表示, 采用t檢驗(yàn)；計(jì)數(shù)資料以率(%)表示, 采用χ2檢驗(yàn)。P＜0.05表示差異具有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

觀察組患者糖尿病病程較對(duì)照組短, 尿蛋白定量較對(duì)照組少, 差異均有統(tǒng)計(jì)學(xué)意義(P＜0.05)；觀察組在高血壓病變、視網(wǎng)膜病變方面的發(fā)生率分別為64.0%、24.0%, 對(duì)照組在高血壓病變、視網(wǎng)膜病變方面的發(fā)生率分別為84.6%, 57.7%,差異均有統(tǒng)計(jì)學(xué)差異(P＜0.05)。見(jiàn)表1。觀察組64%患者尿蛋白定量<1 g/24 h, 13%≥3.5 g/24 h；而對(duì)照組90%患者尿蛋白定量≥3.5 g/24 h。

表1 兩組病程、尿蛋白定量及高血壓病變、視網(wǎng)膜病變發(fā)生率比較(±s, %)

表1 兩組病程、尿蛋白定量及高血壓病變、視網(wǎng)膜病變發(fā)生率比較(±s, %)

注：兩組比較, P＜0.05

項(xiàng)目 觀察組(n=25)對(duì)照組(n=26) P糖尿病病程(個(gè)月) 46±3 80±14 <0.05尿蛋白定量(g/24h) 2.83±0.82 3.68±0.91 <0.05高血壓 64.0 84.6 <0.05糖尿病視網(wǎng)膜病變 24.0 57.7 <0.05

3 小結(jié)

DN是糖尿病較嚴(yán)重的并發(fā)癥, DN患者常與其他腎臟疾病并存, 常見(jiàn)IgA腎病。本次實(shí)驗(yàn)中在對(duì)比兩組病例發(fā)現(xiàn),觀察組患者病程明顯低于對(duì)照組(P＜0.05), 且尿蛋白定量、視網(wǎng)膜病變及高血壓發(fā)生率低于對(duì)照組。有研究表明, DN中有10%繼發(fā)腎病綜合征, 病理類型以膜性腎病為主, 常在1年之內(nèi)進(jìn)展為腎功能衰竭［3］。提升預(yù)后差。

綜上所述, DN合并IgA腎病的預(yù)后較DN繼發(fā)腎病綜合征的預(yù)后好, 并發(fā)癥少, 尿蛋白少, 高血壓及視網(wǎng)膜病變等并發(fā)癥發(fā)生率低。

［1］唐政, 胡章學(xué), 蔣春明, 等. Ⅱ型糖尿病患者非糖尿病腎病腎臟病變的臨床病理分析. 南京大學(xué)學(xué)報(bào)(自然科學(xué)版), 2001, 37(2):252-255.

［2］劉剛, 王梅, 劉玉春, 等. 2 型糖尿病患者合并非糖尿病性腎損害的臨床病理分析 .中華腎臟病雜志, 2001 , 29(4):226-230.

［3］張波, 劉志紅, 曾彩虹, 等.糖尿病腎病合并非糖尿病腎病腎臟病變的臨床病理分析.中華老年多器官疾病雜志, 2002, 1(3): 180-183.

Comparison of clinical characteristics and complications between diabetic nephropathy complicated with IgA nephropathy patients and patients with diabetic nephropathy and secondary nephrotic syndrome

HUANG Lin, ZANG Yu-ting, YU Chang, et al. Department of Nephrology, Dalian City Friendship Hospital, Dalian 116001, China

ObjectiveTo observe clinical characteristics and complications of type 2 diabetic nephropathy complicated with immunoglobulin A (IgA) nephropathy patients and patients with diabetic nephropathy and secondary nephrotic syndrome.MethodsThere were 25 clinically and pathologically diagnosed type 2 diabetic nephropathy complicated with IgA nephropathy patients as observation group, and another 26 diagnosed patients with type 2 diabetic nephropathy and secondary nephrotic syndrome as control group. Comparisons were made on clinical characteristics and complications between the two groups.ResultsThe observation group had shorter course of diabetes mellitus than the control group, and their difference had statistical significance (P<0.05). The observation group had 64% patients with urine protein quantitation <1.0 g/24 h and 13% patients ≥3.5 g/24 h, while 90% in the control group had with urine protein quantitation ≥3.5 g/24 h. Their difference had statistical significance between the two groups (P<0.05). The observation group had lower incidences of hypertension and retinal complications as 64.0% and 24.0% than the control group, and their difference had statistical significance (P<0.05).ConclusionPatients of type 2 diabetic nephropathy complicated with IgA nephropathy have much shorter disease course than patients with diabetic nephropathy and secondary nephrotic syndrome, and it has lower proteinuria and incidences of hypertension and retinal complications.

Diabetic nephropathy; Immunoglobulin A nephropathy; Nephrotic syndrome

10.14164/j.cnki.cn11-5581/r.2015.21.013

2015-06-29］

116001 大連市友誼醫(yī)院腎內(nèi)科(黃琳)；遼寧國(guó)際旅行衛(wèi)生保健中心(臧宇婷 于暢)；遼寧出入境檢驗(yàn)檢疫局(王曉忠)

【關(guān)鍵詞】糖尿病腎??；免疫球蛋白A型腎病；腎病綜合征