A retrospective cohort study on the pathology and outcomes of type 2 diabetic patients with renal involvement
A retrospective cohort study on the pathology and outcomes of type 2 diabetic patients with renal involvement
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DOI：
10.1007/s11255-020-02657-x
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发表时间：
2020-10-06
影响因子：
2
通讯作者：
Lou, Tan-qi
中科院分区：
文献类型：
--
作者：
Li, Ming;Li, Can-ming;Lou, Tan-qi
目的探讨2型糖尿病(T2 DM)肾脏受累患者的临床、组织学特征与终末期肾病(ESRD)的关系。方法对120例接受肾活检的2型糖尿病患者的临床和病理资料进行回顾性分析。结果糖尿病患者的平均年龄为50.9±11.2年，病程为92.8±41.3个月，平均EGFR为55.1±42.3mL/min/1.73m(2)。在这些患者中，57例(47.5%)诊断为糖尿病肾病(DN)，63例(52.5%)诊断为非糖尿病肾病(NDRD)。NDRD最常见的亚型是膜性肾病。与NDRD组相比，糖尿病肾病组的糖尿病病程更长，肾功能更差，糖尿病视网膜病变的比例更高。Kaplan-Meier分析显示，糖尿病肾病组的5年肾脏存活率仅为41%，而非糖尿病肾病组的5年肾存活率为84%。ESRD定义为EGFR<15mL/min/1.73m(2)。经多因素调整后，糖尿病肾病患者发生终末期肾病的风险是非糖尿病肾病患者的3.81倍。根据肾小球分级，糖尿病肾病组IIA、IIB、III和IV型患者的5年肾存活率分别为88、56、28和15%。Kaplan-Meier分析显示，不同肾小球类型或不同间质纤维化和肾小管萎缩(IFTA)评分之间的肾脏存活率有显著差异。但COX比例风险分析显示，仅IFTA评分(HR2.75，95%CI1.37~5.51，P=0.001)，而不是肾小球分级(HR1.21，95%CI0.73~2.00，P=0.465)可以预测肾脏预后。结论糖尿病肾病患者的预后明显差于非糖尿病肾病患者。与肾小球病变相比，肾小管间质病变与糖尿病肾病患者肾脏死亡的风险更高。
Objective To investigate the association of clinical and histological characteristics and the development of ESRD in T2DM patients with renal involvement. Methods We conducted a retrospective analysis of clinical and pathologic data from T2DM patients who underwent renal biopsy (n = 120). Results The mean age, duration of diabetes, and eGFR were 50.9 +/- 11.2 years, 92.8 +/- 41.3 months, 55.1 +/- 42.3 mL/min/1.73 m(2), respectively. Among these patients, 57 (47.5%) were diagnosed with diabetic nephropathy (DN), and 63 (52.5%) with non-diabetic renal disease (NDRD). The most common subtype of NDRD is membranous nephropathy. Compared with the NDRD group, the DN group had a longer duration of diabetes, worse renal function, and a higher proportion of diabetic retinopathy. Kaplan-Meier analysis showed that the 5-year renal survival rate of the DN group was only 41%, whereas that of the NDRD group was 84%. ESRD was defined as eGFR below 15 mL/min/1.73 m(2). After multivariate adjustment, the risk of ESRD in DN patients was 3.81 times higher than that in NDRD patients. According to Glomerular Class, the 5-year renal survival rate of type IIA, IIB, III, and IV in the DN group was 88, 56, 28, and 15%, respectively. Kaplan-Meier analysis showed that there was a significant difference in renal survival among different glomerular classes or different interstitial fibrosis and tubular atrophy (IFTA) scores. But Cox proportional hazards analysis indicated that only IFTA score (HR 2.75, 95% CI 1.37-5.51,P = 0.001), but not the glomerular class (HR 1.21, 95% CI 0.73-2.00,P = 0.465), could predict renal outcome when adjusting for multivariate. Conclusion The prognosis of DN patients is significantly worse than that of NDRD patients. Compared with glomerular lesions, tubulointerstitial lesions were associated with higher risk for renal death in DN patients.