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目的探讨“国际肾脏病理学会”于2010年发布的DN病理分型标准(下称“2010版新标准”)的临床应用价值。方法对2010年前糖尿病合并肾损害活检标本进行重新阅片和分型,观察肾活检组织病理各分型间的相关性,分析分型与间质肾小管损伤之间的关系,探讨2010版新标准的临床意义。结果既往诊断DN 19例,同时筛出送检时为糖尿病患者,且当时不足以诊断为DN的肾活检标本5例,按照2010版新标准重新阅片后,新增诊断DN 3例,合计诊断DN 22例,其中Ⅰ型1例、Ⅱa型2例、Ⅱb型3例、Ⅲ型14例和Ⅳ型2例,以Ⅲ型DN为主,结合肾小管间质的评分标准,新分型中间质病变轻型8例、中度10例和重度4例。结论 2010版新标准可提高DN诊断标准的敏感性,且细化了病变程度和分型的对应关系,同时重视间质和肾小管损伤的程度、大血管和小血管改变,结合相应改变,丰富了诊断依据,提高DN诊断率,有利于DN的早期诊断和早期治疗,及时控制疾病进展,延长患者的生存期和提高生存质量。
Objective To investigate the clinical application value of DN pathological typing standard (hereinafter referred to as “2010 new standard”) issued by International Society of Nephrology in 2010. Methods The reexamination and classification of the biopsy specimens of diabetic nephropathy before 2010 were carried out to observe the correlation between the histopathological types of renal biopsy and the relationship between the typing and interstitial tubulointerstitial injury Standard clinical significance. Results In the past, 19 cases were diagnosed as DN and 5 cases were diagnosed as DN by the time of screening. At the same time, 5 cases of renal biopsy were not enough to be diagnosed as DN. DN 22 cases, including type Ⅰ in 1 case, type Ⅱ a in 2 cases, type Ⅱ b in 3 cases, type Ⅲ in 14 cases and type Ⅳ in 2 cases, with type Ⅲ DN, combined with tubulointerstitial score criteria, the new type Interstitial lesions were mild in 8 cases, moderate in 10 and severe in 4. Conclusion The new version of 2010 can improve the sensitivity of DN diagnostic criteria, and refine the corresponding relationship between the degree of lesion and the classification. At the same time, we should pay attention to the degree of interstitial and renal tubular injury, macrovascular and small vessel changes, combined with the corresponding changes, rich Diagnostic basis to improve the diagnostic rate of DN is conducive to the early diagnosis and early treatment of DN, timely control of disease progression, prolong the survival of patients and improve the quality of life.