The impact of coexisting diabetes mellitus on clinical outcomes in patients with idiopathic membranous nephropathy: a retrospective observational study
The impact of coexisting diabetes mellitus on clinical outcomes in patients with idiopathic membranous nephropathy: a retrospective observational study
复制标题
共存糖尿病对特发性膜性肾病患者临床结局的影响：一项回顾性观察研究
DOI：
10.1186/s12882-020-01878-7
复制
发表时间：
2019-09
期刊：
影响因子：
2.3
通讯作者：
Liang Xinling
中科院分区：
文献类型：
--
作者：
Xie Zhiyong;Li Zhilian;Dong Wei;Chen Yuanhan;Li Ruizhao;Wu Yanhua;Liang Huaban;Ye Zhiming;Liu Shuangxin;Shi Wei;Liang Xinling
背景特发性膜性肾病（IMN）常与糖尿病（DM）并存。很少有研究探讨IMN患者合并糖尿病（DM）的临床结局，包括缓解率、肾脏存活率和并发症。由于糖皮质激素和免疫抑制剂对代谢紊乱的影响，并发糖尿病也给IMN患者的治疗带来了挑战。我们进行了这项研究，以探讨糖尿病对IMN的临床结局的影响和治疗制度对代谢参数的影响，在糖尿病IMN patient.MethodsTwo和6例确诊为IMN的成人住院患者活检证实，回顾性研究，其中包括42例与糖尿病共存。比较两组的临床结局，包括缓解率、肾脏结局和并发症。结果IMN合并DM患者年龄大、eGFR低、血红蛋白水平低。合并糖尿病患者肾功能恶化程度加重，感染发生率增高。考克斯回归分析显示糖尿病是IMN患者肾功能恶化的独立危险因素。两组缓解率及静脉血栓栓塞发生率差异无统计学意义。进一步探讨治疗方案对并发症和代谢的影响，环磷酰胺和环孢素在感染和静脉血栓栓塞等并发症的发生率方面无显著差异，对血糖的影响相当，结论糖尿病是IMN患者肾功能恶化的独立危险因素，但不影响IMN患者的肾功能蛋白尿的缓解。糖皮质激素联合环磷酰胺或环孢素对IMN合并DM患者并发症及血糖、尿酸、血脂等代谢指标的影响相似。
BackgroundIdiopathic membranous nephropathy (IMN) is frequently coexisted with diabetes mellitus (DM). Few researches investigate clinical outcomes in IMN patients coexisting diabetes mellitus (DM), including remission rates, renal survival and complications. Concurrent DM also pose therapeutic challenges to IMN patients due to the influence of glucocorticoids and immunosuppressant on metabolic disorders. We performed this study to investigate the impact of DM on clinical outcomes in IMN and the influence of therapeutic regime on metabolic parameters in diabetic IMN patients.MethodsTwo hundred and six adult hospitalized patients diagnosed with biopsy-proven IMN were retrospectively studied, including 42 patients coexisted with DM. Clinical outcomes including remission rates, renal outcome and complications were compared between groups. Impact of cyclophosphamide and ciclosporin on metabolism and complications were analyzed in IMN patients coexisting DM.ResultsIMN patients coexisted with DM were presented with advanced age, lower level of eGFR and hemoglobin. Patients coexisted with DM experienced worse renal function deterioration and higher incidence of infection. COX regression analysis showed that DM was an independent risk factor for renal function deterioration in IMN patients. There was no significant difference in remission rates and incidence of venous thromboembolism between two groups. Further exploration on the impact of therapeutic regimens on complications and metabolism showed that cyclophosphamide and ciclosporin had no significant difference in incidence of complications including infection and venous thromboembolism, and posed comparable influences on blood glucose, uric acid and blood lipids in IMN patients coexisted with DM.ConclusionCoexisting DM was an independent risk factor for renal function deterioration in IMN patients but did not influence the remission of proteinuria. Glucocorticoids in combination with cyclophosphamide or ciclosporine had similar impact on complications and metabolic index including blood glucose, uric acid and blood lipids in IMN patients coexisted with DM.
登录
查看更多内容
影响因子：
2
作者：
Liu, Shujun;Guo, Qiaoyan;Han, Hongbo;Cui, Peihe;Liu, Xiao;Miao, Lining;Zou, Hongbin;Sun, Guangdong
通讯作者：
Sun, Guangdong
影响因子：
5.3
作者：
通讯作者：
--
影响因子：
3
作者：
Yu X;Ruan L;Qu Z;Cui Z;Zhang Y;Wang X;Meng L;Liu X;Wang F;Zhang Y;Liu G;Yang L
通讯作者：
Yang L
影响因子：
5.5
作者：
通讯作者：
--
影响因子：
158.5
作者：
Yang, Wenying;Lu, Juming;He, Jiang
通讯作者：
He, Jiang