关键词: 关键词：病理分型, 糖尿病肾病, 预后

Abstract:

ABSTRACT   objective: To evaluate the predictive power of the pathologic classification in type 2 diabetes mellitus (T2DM).  Methodology:  Four hundred and fourteen T2DM patients who had biopsy-confirmed DN and followed for at least a year after biopsy from January 2003 to November 2011 at Jinling Hospital were enrolled in this retrospective study. The relevancies between pathological findings and renal outcome were assessed. All cases were categorized according to the pathologic classification of Tervaert having reported. Some common pathological changes of DN were also examined. A renal event was defined as eGFR<15 ml/(min.1.73m2).   Results: They were 260 male and 154 female with an average age of 50.0±9.10 years old. Among them, there were 63 in Class I, 95 Class IIa , 32 Class IIb , 168 Class III, and 56 Class IV. The 5-year renal survival rates were 100%, 90%, 75%, 39% and 15%, respectively. Cox regression showed that the glomerular classes, interstitial fibrosis and tubular atrophy (IFTA) and interstitial inflammation can significantly influence renal survival in these patients. Scores of arteriolar hyalinosis and arteriosclerosis were not significant variables. More than one area of arteriolar hyalinosis was commonly found in 95.4% of these patients, indicating that this index may not be suitable for classification. The patient with nodule lesions, glomerular microaneurysms, atubular glomeruli, segmental sclerosis, hyaline caps, fibrinoid exudation, foam cells within loops, glomerular inflammation, crescents, and segmental endothelial proliferation had a worse renal survival. Multivariate COX analysis showed that the glomerular classes, IFTA and acute tubular injury were independent risk factors for renal prognosis, even when adjusted for proteinuria, blood pressure and eGFR. Conclusion: The glomerular classification and IFTA are significantly associated with renal outcome in patients with T2DM, independently of proteinuria, blood pressure and eGFR. However, the vascular indexes in the classification are incapable to reflect the difference in vascular lesion severity of the patients and can’t be used for renal prognosis, suggesting a necessity to redefine them.