糖尿病肾病微量白蛋白尿患者肾脏组织损伤及病情变化的研究

肾脏病与透析肾移植杂志 ›› 2015, Vol. 24 ›› Issue (3): 207-212.

糖尿病肾病微量白蛋白尿患者肾脏组织损伤及病情变化的研究

出版日期:2015-06-28 发布日期:2015-07-01

Renal histological injury and the progression in diabetic nephropathy patients with microalbuminuria

Online:2015-06-28 Published:2015-07-01

摘要/Abstract

摘要：

摘要：目的：观察中国人群中2型糖尿病患者尿微量白蛋白（MAU）进展和缓解的临床与病理影响因素，并分析其对肾小球滤过率（GFR）下降的影响。
方法：纳入尿白蛋白定量30~300mg/24h，血清肌酐≤109.62?mol/L，并愿意接受肾活检的2型糖尿病患者61例。记录患者基线年龄、糖尿病病程、是否伴有高血压、吸烟史、服药史等一般情况，以及eGFR、血脂、空腹血糖、糖化血红蛋白、尿白蛋白定量、尿NAG酶、RBP等临床指标，以及肾小球硬化比例、体积、系膜区面积百分比、基膜厚度、足细胞足突宽度、足细胞裂孔膜分布密度等病理指标。eGFR快速下降定义：随访中eGFR平均每年下降≥3.3%。
结果：61例患者中失访7例，54例纳入分析，MAU进展组22例（40.74%），MAU稳定组25例（46.30%），MAU转阴组7例（12.96%）。MAU转阴组基线尿白蛋白定量显著低于稳定组和进展组（103.05±53.88 vs 139.58±76.88 vs 192.58±97.64mg/24h，P=0.025），HDL水平显著高于稳定组和进展组（1.38±0.34 vs 0.94±0.23 vs 1.04±0.37mmol/L，P=0.006），足细胞裂孔膜分布密度显著高于稳定组和进展组（1.01±0.21 vs 0.78±0.21vs 0.58±0.30个/μm，P=0.003）。多因素COX回归分析，显示足细胞裂孔膜分布密度（HR=0.029，P<0.001）和肾小球体积（HR=0.513，P=0.018）是MAU进展的独立影响因素；DM病程（HR=0.925，P=0.012）、血尿酸（HR=1.012，P=0.034）、总胆固醇（HR=4.235，P=0.021）、ACEI/ARB使用（HR=311.451，P=0.006）是MAU转阴/缓解的独立影响因素。多因素Logistic回归分析，显示基线eGFR（HR=0.853，P=0.010）、血尿酸（HR=1.019，P=0.016）是eGFR下降的独立风险因素。
结论：临床表现为MAU的2型糖尿病肾病患者基线临床病理指标能够预测MAU进展与缓解，基线eGFR和血尿酸能够预测eGFR下降。

关键词: 2型糖尿病, 微量白蛋白尿, 肾组织病理, 肾小球滤过率, 风险因素

Abstract:

ABSTRACT Objective: To investigate the clinical and histological risk factors and to predict the progression to macroalbuminuria, remission to normoalbuminuira and eGFR decline in type 2 diabetic patients with microalbuminuria. Methodology: Sixty one type 2 diabetic patients with MAU (urinary albumin excretion 30~300mg/24h) and serum creatinine ≤1.24mg/dl who received renal biopsy were enrolled in this study. The clinical data such as baseline age, duration of diabetes mellitus, blood pressure, smoking history, ACEI/ARB prescription, serum creatinine, eGFR, serum lipid, HbA1c, urinary albumin, NAG and RBP were recorded. The histological data including the percentage of global sclerosis, glomerular volume, mesangial area ratio, glomerular basement membrane width, podocyte foot process width, slit diaphragm frequency were also measured. eGFR rapid decline was defined as a rate of eGFR loss of ≥3.3% per year. Results: 54 patients were included for analyzing, and 7 patients were lost during follow-ups. 40.7% (22/54) patients progressed to macroalbuminuria, 46.3% (25/54) were stable and 13.0% (7/54) were remission to normoalbuminuria. The urinary albumin at baseline was lower in remission group than that in progression and stable groups（103.05±53.88 vs 139.58±76.88 vs 192.58±97.64mg/24h，P=0.025）, and the SD frequence was higher in remission group than that in other two groups. Multivariate COX regression analysis indicated that SD frequence and glomrular volume were independent predictors of progression to macroalbuminuria, and DM duration, serum uric acid, cholesterol and ACEI/ARB prescription were independent infect factors of remission to normoalbuminuria. Multivariate Logistic regression analysis indicated that lower baseline eGFR and higher serum uric acid concentration were the independent predictors of eGFR decline in this cohort. Conclusion: Multiple clinical and histological indices can predict the progression and remission of MAU in type 2 diabetic nephropathy, and baseline eGFR and serum uric acid concentration can predict the decline of eGFR.

Key words: diabetic nephropathy, microalbuminuria, renal histological injury, GFR, risk factors

葛永纯|谢红浪|徐峰|等. 糖尿病肾病微量白蛋白尿患者肾脏组织损伤及病情变化的研究[J]. 肾脏病与透析肾移植杂志, 2015, 24(3): 207-212.

GE Yongchun|XIE Honglang|XU Feng|et al. Renal histological injury and the progression in diabetic nephropathy patients with microalbuminuria[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2015, 24(3): 207-212.

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