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目的探讨伴与不伴水肿的糖尿病肾病(diabetic nephropathy,DN)患者的临床与病理特征。方法将病理诊断明确的170例DN患者分成水肿型DN组(edema DN,E-DN)和非水肿型DN组(nonedema DN,NE-DN),比较两组患者的临床和病理特征及预后间的差异。结果与基线值比较,E-DN组肾脏病理改变重,糖化血红蛋白(Hb A1c)、血压(BP)、总胆固醇(TC)、24 h尿蛋白定量>3.5 g的百分比等均显著高于NE-DN组(P<0.05,P<0.01),而e GFR和血浆白蛋白(ALB)、尿比重、尿渗透压等均显著低于NE-DN组(P<0.05,P<0.01)。随访2年,E-DN组e GFR下降速率均显著大于NEDN组(P<0.05),肾脏终点事件发生率、肾外并发症发病率也显著高于NE-DN组(P<0.05)。生存分析显示E-DN组预后差(χ~2=17.460,P<0.01)。危险因素分析发现肾活检时ALB(RR=0.938,P=0.004)、e GFR(RR=0.985,P<0.01)、肾脏间质病变(RR=1.236,P=0.012)、TC(RR=1.192,P=0.015)、水肿(RR=6.412,P<0.01)是DN肾脏死亡的独立危险因素。结论伴有水肿的DN患者较不伴有水肿的DN患者血糖控制较差、ALB低、脂质代谢紊乱、肾脏间质病变重、肾脏中位生存时间短,水肿为影响肾脏死亡的独立危险因素。
Objective To investigate the clinical and pathological features of diabetic nephropathy (DN) with and without edema. Methods One hundred and seventy patients with DN were divided into two groups: edema DN (E-DN) and nonedema DN (NE-DN). The clinical and pathological features and prognosis The difference. Results Compared with the baseline value, the pathological changes of kidney in HN-E-DN group were significantly higher than that of NE-H group (Hb A1c), blood pressure (BP), total cholesterol (TC) DN group (P <0.05, P <0.01), while eGFR and ALB, urinary specific gravity and urine osmotic pressure were significantly lower than those in NE-DN group (P <0.05, P <0.01). After 2 years of follow-up, the decline rate of e GFR in E-DN group was significantly greater than that in NEDN group (P <0.05). The incidence of end-point renal events and extra-renal complications were also significantly higher in E-DN group than in NE-DN group. Survival analysis showed poor prognosis in E-DN group (χ ~ 2 = 17.460, P <0.01). The analysis of risk factors showed that there was significant difference in ALB (RR = 0.938, P = 0.004), e GFR (RR = 0.985, P 0.01), renal interstitial lesions (RR 1.236, P = 0.015). Edema (RR = 6.412, P <0.01) was an independent risk factor for DN renal death. Conclusions DN patients with edema and edema in DN patients are less likely to have poor glycemic control, low ALB, dyslipidemia, severe renal interstitial disease, and shorter median survival time in nephrons. Edema is an independent risk factor for renal death .