摘要
背景随着2型糖尿病(T2DM)年轻化趋势,微小病变肾病(MCD)合并T2DM在临床上已不罕见,但其临床病理特点及预后情况仍不清楚。目的本文旨在分析MCD合并T2DM患者的病理特点及其预后。方法收集2017年6月1日-2018年6月1日在郑州大学第一附属医院肾内科就诊且肾穿刺活检确诊为MCD合并T2DM患者20例(MCD合并T2DM组),MCD患者306例,利用SPSS 22.0软件从306例MCD患者中随机筛选出100例(单纯MCD组),收集所有患者当次肾穿刺活检的临床和病理资料,以及随访资料(从患者首次肾穿刺活检开始随访,到出现复发或到2019年6月随访结束),回顾性分析其临床表现、肾脏病理特点及其预后。采用单因素Logistic回归分析及多因素Logistic回归分析探讨MCD合并T2DM的影响因素,采用Log-rank检验比较单纯MCD及MCD合并T2DM的累积完全缓解(CR)率和累积无复发生存率。结果MCD合并T2DM组患者年龄、收缩压(SBP)、合并高血压所占比例、血糖、糖化血红蛋白(HbA1c)、清蛋白(ALB)、IgG水平高于单纯MCD组,男性所占比例、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、红细胞沉降率(ESR)、24 h尿蛋白量低于单纯MCD组(P<0.05)。MCD合并T2DM患者的血管损伤程度、肾小管萎缩程度、肾间质纤维化、肾间质炎症、球性硬化小球所占比例高于单纯MCD组(P<0.05)。单因素Logistic回归分析结果显示,性别〔OR=5.108,95%CI(1.717,15.200)〕、年龄〔OR=1.068,95%CI(1.006,1.133)〕、高血压〔OR=6.000,95%CI(1.982,18.165)〕、HbA1c〔OR=84.019,95%CI(12.465,566.317)〕、ALB〔OR=1.173,95%CI(1.100,1.250)〕、TC〔OR=0.730,95%CI(0.619,0.861)〕、ESR〔OR=0.978,95%CI(0.960,0.996)〕、24 h尿蛋白量〔OR=0.818,95%CI(0.705,0.948)〕、IgG〔OR=1.568,95%CI(1.288,1.908)〕、球形硬化小球占比〔OR=13.286,95%CI(4.142,42.614)〕、血管损伤程度、肾小管萎缩、肾间质纤维化〔OR=17.000,95%CI(4.833,59.794)〕、肾间质炎症〔OR=10.111,95%CI(2.684,38.087)〕是MCD合并T2DM的影响因素(P<0.05);多因素Logistic回归分析结果显示,IgG水平〔OR=1.476,95%CI(1.190,1.831)〕、血管损伤程度、肾间质纤维化〔OR=12.433,95%CI(2.032,76.065)〕是MCD合并T2DM的影响因素(P<0.05)。Log-rank检验结果表明,MCD合并T2DM组的累积CR率低于单纯MCD组(P=0.027),但两组累积无复发生存率无统计学差异(P=0.318)。结论与单纯MCD患者相比,MCD合并T2DM患者的临床表现较轻微,但病理表现却相对较重,提示临床医师肾穿刺活检的重要性。肾间质纤维化、血管损伤程度重、高IgG水平是MCD合并T2DM的危险因素,且MCD合并T2DM的预后较差。
Background In recent years,type 2 diabetes(T2DM)incidence is increasing in the young population,and minimal change disease(MCD)combined with T2DM is becoming less uncommon clinically.But the clinical and pathological characteristics and prognosis of MCD with T2DM are still unclear.Objective To analyze the clinical and pathological characteristics and prognosis of patients with MCD combined with T2DM.Methods Participants with renal biopsyconfirmed MCD were recruited from Department of Nephrology,the First Affiliated Hospital of Zhengzhou University during from June 1,2017 to June 1,2018,including 20 with MCD and T2DM(MCD with T2DM group),and 100 with MCD(MCD group)from 306 with simple MCD using a random number table generated by the SPSS 22.0.The clinicopathological and follow-up data of all patients(follow up from the first renal biopsy to recurrence or to June 2019)were collected,and clinical manifestations,pathological characteristics and prognosis were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to explore the independent risk factors of MCD with T2DM.Log-rank test was used to compare the cumulative complete remission rate and cumulative relapse-free survival rate of MCD and MCD with T2DM groups.Results Compared with the MCD group,the median age,systolic blood pressure(SBP),fasting blood glucose,serum glycosylated hemoglobin(HbA1c),albumin(ALB)and serum IgG levels and prevalence of hypertension were higher,and male ratio,median levels of total cholesterol(TC),high-density lipoprotein(HDL),low-density lipoprotein(LDL)erythrocyte sedimentation rate(ESR),and 24-hour quantitative proteinuria were lower in MCD with T2DM group(P<0.05).Moreover,MCD with T2DM group also showed higher rates of having higher severity of vascular injury and renal tubular atrophy,and higher prevalence of renal interstitial fibrosis,renal interstitial inflammation and glomerular sclerosis(P<0.05).Univariate Logistic regression analysis showed that sex〔OR=5.108,95%CI(1.717,15.200)〕,age〔OR=1.068,95%CI(1.006,1.133)〕,hypertension〔OR=6.000,95%CI(1.982,18.165)〕,HbA1c〔OR=84.019,95%CI(12.465,566.317)〕,ALB〔OR=1.173,95%CI(1.100,1.250)〕,TC〔OR=0.730,95%CI(0.619,0.861)〕,ESR〔OR=0.978,95%CI(0.960,0.996)〕,24-hour quantitative proteinuria〔OR=0.818,95%CI(0.705,0.948)〕,IgG〔OR=1.568,95%CI(1.288,1.908)〕,prevalence of glomerular sclerosis〔OR=13.286,95%CI(4.142,42.614)〕,the severity of vascular injury,renal tubular atrophy and interstitial fibrosis〔OR=17.000,95%CI(4.833,59.794)〕and renal interstitial inflammation〔OR=10.111,95%CI(2.684,38.087)〕were associated with MCD combined with T2DM(P<0.05).Multivariate logistic regression analysis showed that IgG level〔OR=1.476,95%CI(1.190,1.831)〕and the severity of vascular injury and renal interstitial fibrosis〔OR=12.433,95%CI(2.032,76.065)〕were associated with MCD combined with T2DM(P<0.05).Log-rank test showed that the cumulative complete remission rate of MCD with T2DM group was significantly lower than that of MCD group(P=0.027).However,there was no significant difference in cumulative relapse-free survival rate of between the two groups(P=0.318).Conclusion Compared with the MCD group,the clinical manifestations of MCD with T2DM group are relatively slighter,but the pathological manifestations are more serious,which indicates the importance of renal biopsy by clinicians.Renal interstitial fibrosis,severe vascular injury,and elevated IgG level are risk factors for MCD combined with T2DM.The prognosis of MCD combined with T2DM is poor.
作者
姚星辰
翟亚玲
高静歌
陈雅卓
王新念
卢珊
赵占正
YAO Xingchen;ZHAI Yaling;GAO Jingge;CHEN Yazhuo;WANG Xinnian;LU Shan;ZHAO Zhanzheng(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Institute of Nephrology,Zhengzhou University,Zhengzhou 450052,China)
出处
《中国全科医学》
CAS
北大核心
2021年第2期183-189,共7页
Chinese General Practice
基金
国家自然科学青年基金项目(81600555)
中国博士后科学基金面上项目(2018M640684)。
关键词
肾小球病
微小病变性
糖尿病
2型
微小病变性肾病
预后
临床病理特点
Glomerulopathy,minimal change
Diabetes mellitus,type 2
Minimal change disease
Prognosis
Clinicopathologic characteristics
