2型糖尿病肾病伴非酒精性脂肪肝患者临床特征

肾脏病与透析肾移植杂志 ›› 2010, Vol. 19 ›› Issue (6): 516-521.

2型糖尿病肾病伴非酒精性脂肪肝患者临床特征

出版日期:2010-12-28 发布日期:2011-01-04

Clinical features in patients with type 2 diabetic nephropathy and nonalcoholic fatty NAFLD

Online:2010-12-28 Published:2011-01-04

摘要/Abstract

摘要：

目的：观察伴有非酒精性脂肪肝（nonalcoholic fatty liver disease NAFLD）的2型糖尿病肾病患者临床及肾脏病理特点。方法：收集355例肾活检诊断为2型糖尿病肾病患者的一般情况、血液生化、尿液检测、肾脏病理等资料，并行彩色B型超声波检查，以明确NAFLD病变患者，分析同时伴有NAFLD的2型糖尿病肾病了患者临床以及肾脏病理特点。结果： 62例2型糖尿病肾病患者同时伴有NAFLD（占17.46%），与无脂肪肝患者相比有以下特点：1.年龄相对较轻（49.08±9.04 vs 53.85±9.61，p<0.001），糖尿病病程显著短于后者（61±57.68月vs 277±72.40月，p<0.001）；2. BMI显著增高（28.75±3.24kg/m² vs 24.9±3.48 kg/m²，p<0.001），胰岛素抵抗指数也更显著（7.15±4.28 vs 5.17±4.39，p=0.028），甘油三酯水平也显著升高（3.52±4.03mmol/l vs 2.11±1.46 mmol/l，p<0.001），而高密度脂蛋白水平显著低于后者（p=0.008），胆固醇水平无显著差异（p=0.818）；3.血肌酐水平显著低于后者（1.07±1.04mg/dl vs 2.17±2.05mg/dl，p<0.001），24小时尿蛋白定量显著低于后者（2.21±3.44g vs 3.63±2.80g，p=0.001），小分子蛋白尿比例显著低后者（7.67±13.39% vs 11.54±11.72%，p=0.027）；4. 糖尿病背景视网膜病变（17.20％ vs 64.90%）以及末梢神经病变(31.10% vs 55.10%)均显著低于后者（p<0.001）；5. 肾小球球性硬化比例、系膜增生程度、K-W结节比例、小管间质病变程度均显著低于后者（p均<0.001）。结论：本文发现伴有NAFLD的2型糖尿病肾病患者年龄相对较轻，糖尿病病程相对较短，存在明显的代谢紊乱、超重和胰岛素抵抗，其中甘油三酯升高及高密度脂蛋白降低与NAFLD密切相关；而肾脏等靶器官损害相对较轻。因此，代谢异常在伴有NAFLD的2型糖尿病肾病患者更为突出，提示控制代谢异常对此类患者的意义更为重大。

Abstract:

Objective: To investigate clinical and kidney histological features in patients with type 2 diabetic nephropathy and nonalcoholic fatty liver disease (NAFLD). Methodology: Three hundred and fifty five cases with type 2 diabetic nephropathy were enrolled in this study. The general information, blood biochemistry and urine test as well as kidney pathological data of patients were collected. The patients with NAFLD were identified by type B ultrasonic sound test. The clinical and histological features of kidney injury were also analyzed. Results: Sixty two cases of 355 (17.5%) subjects were diagnosed as NAFLD. Compared with patients without NAFLD, NAFLD patients were significantly younger[（49.1±9.04） vs (53.9±9.61 )years old, P<0.01] and a shorter course of diabetes mellitus [（61.0±57.7） vs (277±72.4 )months, P<0.01]. In patients with NAFLD, their body mess index (BMI) was obviously higher[（28.8±3.24） vs (24.9±3.48) kg/m²，P<0.01], insulin resistance index was much more severer（7.15±4.28） vs (5.17±4.39)，P<0.05）, triglyceride level was also significantly elevated[（3.52±4.03）vs (2.11±1.46 )mmol/l, P<0.01], while high density lipoprotein (HDL) level was significantly lower（P<0.01）than that in patients without NAFLD. There was no statistic difference in total cholesterol level between two groups. The level of serum creatinine (Scr) was significantly lower[（1.07±1.04） vs (2.17±2.05)mg/dl, P<0.01], total urine protein and low molecular urine protein were also significantly lower in NAFLD group[（2.21±3.44） vs (3.63±2.80)g，P<0.01 and (7.67±13.39) vs (11.54±11.72)%， P<0.05, respectively]. The rate of glomerular sclerosis, mesengial proliferation, K-W nodular and tubular-interstitial lesion were much more predominant in non- NAFLD patients. Conclusion: The patients with type 2 diabetic nephropathy and NAFLD were comparably younger with shorter course of diabetes mellitus. The metabolic disturbance was much more significant in these patients characterized as overweight, insulin resistance , hypertriglyceridemia and low HDL, which may implicated that metabolic control is very important in the treatment of type 2 diabetic nephropathy patients with NAFLD.

张义德, 谢红浪, 葛永纯, 等. 2型糖尿病肾病伴非酒精性脂肪肝患者临床特征[J]. 肾脏病与透析肾移植杂志, 2010, 19(6): 516-521.

ZHANG Yi-de, XIE Hong-lang, GE Yong-chun, et al. Clinical features in patients with type 2 diabetic nephropathy and nonalcoholic fatty NAFLD[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2010, 19(6): 516-521.

ISSN 1006-298X CN 32-1425/R