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目的分析2型糖尿病(T2DM)合并肾损害的临床病理特点,探讨肾穿刺活检在诊断T2DM合并肾损害时的重要性。方法回顾性分析177例T2DM合并肾损害患者的临床资料及肾穿刺活检的病理资料。结果 177例2型糖尿病合并肾损害患者占同期全部肾穿刺活检患者的6.7%(177/2653),其中女性56例,男性121例。患者年龄24~76岁,平均年龄53.4岁。病理诊断糖尿病肾病(DN)62例,非糖尿病肾病(NDRD)106例,DN合并NDRD 9例。62例DN中,I型DN 2例,IIa型5例,IIb型8例,Ⅲ型41例,Ⅳ型6例。106例NDRD中,Ig A肾病27例,膜性肾病24例,系膜增生性肾小球肾炎21例,高血压肾损伤7例,肾小管间质性炎6例,局灶节段性肾小球硬化症(FSGS)和局灶增生硬化性肾小球肾炎各5例,ANCA相关性血管炎性肾损伤4例,增生硬化性肾小球肾炎3例,淀粉样变性肾病、膜增生性肾小球肾炎、过敏性紫癜性肾炎和新月体性肾小球肾炎各1例。9例DN合并NDRD中,Ⅲ型DN+Ig A肾病、IIa型DN+膜性肾病和Ⅲ型DN+局灶增生性肾小球肾炎各2例,Ⅲ型DN+系膜增生性肾小球肾炎、Ⅲ型DN+ANCA相关性血管炎性肾损伤和IIb型DN+Ⅳ型狼疮性肾炎各1例。结论 T2DM合并肾损害可以是DN也可以是NDRD,还可以是DN合并NDRD,不同的病理类型在临床治疗和预后上有很大的差异。肾穿刺活检可以从组织学上明确诊断,为治疗和判断预后提供依据。
Objective To analyze the clinicopathological features of type 2 diabetes mellitus (T2DM) with renal damage and to explore the importance of renal biopsy in the diagnosis of T2DM with renal impairment. Methods Retrospective analysis of 177 cases of T2DM with renal damage in patients with clinical data and renal biopsy pathological data. Results A total of 177 patients with type 2 diabetes mellitus and renal damage accounted for 6.7% (177/2653) of the total renal biopsy patients in the same period, including 56 females and 121 males. Patients aged 24 to 76 years, mean age 53.4 years old. Pathological diagnosis of diabetic nephropathy (DN) 62 cases, 106 cases of non-diabetic nephropathy (NDRD), DN with NDRD in 9 cases. Of the 62 DN patients, 2 were type I DN, 5 were type IIa, 8 were type IIb, 41 were type III and 6 were type IV. 106 cases of NDRD, IgA nephropathy in 27 cases, membranous nephropathy in 24 cases, mesangial proliferative glomerulonephritis in 21 cases, hypertensive renal injury in 7 cases, tubulointerstitial inflammation in 6 cases, focal segmental renal 5 cases of glomerulosclerosis (FSGS) and focal proliferative glomerulonephritis, 4 cases of ANCA-associated vasculitic renal injury, 3 cases of proliferative glomerulonephritis, amyloid nephropathy, membranous hyperplasia Glomerulonephritis, anaphylactoid purpura nephritis and crescentic glomerulonephritis in 1 case. There were 2 cases of DN + IgA nephropathy, 2 cases of DN + membranous nephropathy and 3 cases of DN + focal proliferative glomerulonephritis, 9 cases of DN combined with NDRD, 3 cases of DN + mesangial proliferative glomerulonephritis, Ⅲ DN + ANCA-associated vasculitic renal injury and type IIb DN + Ⅳ lupus nephritis in 1 case. Conclusions T2DM with renal impairment can be DN or NDRD, but also DN with NDRD. Different pathological types have great differences in clinical treatment and prognosis. Kidney biopsy can be diagnosed histologically, to provide the basis for the treatment and prognosis.