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Analysis of clinical and pathological characteristics in patients with type 2 diabetes mellitus complicated with renal damage
Jin Li, Wang Xiaopei, Wang Zhigang, Lan Ping, Liu Hui, Lu Wanhong
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Analysis of clinical and pathological characteristics in patients with type 2 diabetes mellitus complicated with renal damage
It was a retrospective study. The patients with type 2 diabetes mellitus (T2DM) who underwent renal biopsy in the Department of Nephrology, the First Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2021 were enrolled to analyze the pathological and clinical manifestations of kidney. There were 483 patients enrolled, including 136 patients who had no history of diabetes mellitus, newly diagnosed as T2DM according to an oral glucose tolerance test. The age was (52.80±13.13) years old. There were 337 males (69.77%). Based on the renal biopsy, the patients were classified as diabetic kidney disease (DKD, 22.15%, 107/483), DKD+non-diabetic kidney disease (NDKD)(6.63%, 32/483), and NDKD (71.22%, 344/483). Membranous nephropathy was the most common pathology in patients with NDKD (40.41%, 139/344) and DKD+NDKD (34.38%, 11/32). In the 136 newly diagnosed T2DM patients, there were 3 patients (2.21%) with DKD, 2 patients (1.47%) with DKD+NDKD, and 131 patients with NDKD (96.32%). The proportions of DKD in patients with diabetes history ≤3 months, 3-12 months, 1-5 years, 5-10 years and ≥10 years were 10.53% (6/57), 25.00% (16/64), 26.53% (26/98), 41.56% (32/77) and 47.06% (24/51), respectively. The proportions of DKD+NDKD in patients with diabetes history ≤3 months, 3-12 months, 1-5 years, 5-10 years and ≥10 years were 3.51% (2/57), 3.13% (2/64), 10.20% (10/98), 9.09% (7/77) and 17.65% (9/51), respectively. Multivariate logistic regression analysis results showed that, the duration of diabetes history (OR=1.130, 95% CI 1.057-1.208, P<0.001), diabetes retinopathy (OR=12.185, 95% CI 5.331-27.849, P<0.001), urinary red blood cell count (OR=0.987, 95% CI 0.974-0.999, P=0.039), glycosylated hemoglobin (OR=1.482, 95% CI 1.119-1.961, P=0.006) as well as hemoglobin (OR=0.973, 95% CI 0.957-0.990, P=0.001) were independently correlated with DKD. The proportions of DKD and DKD+NDKD increase with the prolongation of diabetes history. Membranous nephropathy is the most common pathology in NDKD and DKD+NDKD patients. Even in patients newly diagnosed with T2DM, it is necessary to screen for DKD. The duration of diabetes history, diabetes retinopathy, urinary red blood cell count, glycosylated hemoglobin and hemoglobin may be used to identify DKD from NDKD.
Diabetes mellitus, type 2 / Diabetic nephropathies / Diabetic kidney disease / Non-diabetic kidney disease {{custom_keyword}} /
表1 三组肾活检患者临床资料比较 |
| 项目 | DKD组（n=107） | DKD+NDKD组（n=32） | NDKD组（n=344） | 统计值（F/H/χ 2） | P值 |
|---|---|---|---|---|---|
| 男性［例（%）］ | 83（77.57） | 28（87.50） | 226（65.70）ab | 10.561 | 0.005 |
| 年龄（岁） | 51.46±12.95 | 51.66±12.75 | 53.32±13.23 | 0.946 | 0.389 |
| 体重指数（kg/m2） | 24.57±3.08 | 26.43±3.49a | 25.77±3.64a | 5.574 | 0.005 |
| 尿红细胞计数/高倍镜 | 3.00（1.13，7.40） | 4.60（1.90，13.80） | 6.00（1.70，19.85） | 10.692 | 0.076 |
| 24 h尿蛋白量（g） | 3.48±2.33 | 3.56±2.33 | 2.89±2.28ab | 3.519 | 0.030 |
| 血清白蛋白（g/L） | 32.61±8.40 | 32.15±9.70 | 30.14±8.76 | 1.714 | 0.181 |
| eGFR［ml·min-1·（1.73 m2）-1］ | 58.53（35.95，87.86） | 59.78（32.71，90.26） | 77.22（34.87，106.22） | 4.848 | 0.089 |
| 空腹血糖（mmol/L） | 8.38±4.20 | 9.44±5.33 | 7.32±3.46ab | 6.523 | 0.002 |
| 糖化血红蛋白（%） | 7.13±1.67 | 7.30±1.33 | 6.65±1.31ab | 6.108 | 0.002 |
| 补体C4（g/L） | 0.31±0.09 | 0.28±0.07 | 0.31±0.11 | 1.051 | 0.350 |
| 补体C3（g/L） | 1.10±0.36 | 1.05±0.12 | 1.14±0.25 | 2.343 | 0.097 |
| 三酰甘油（mmol/L） | 1.96±1.00 | 2.21±1.35 | 2.21±1.35a | 6.028 | 0.003 |
| 总胆固醇（mmol/L） | 4.90±1.61 | 4.97±1.60 | 5.45±2.25a | 3.034 | 0.049 |
| 血红蛋白（g/L） | 115.70±25.33 | 128.07±20.95a | 131.60±24.05a | 16.230 | <0.001 |
| 高血压［例（%）］ | 44（41.12） | 16（50.00） | 219（63.66）a | 17.844 | <0.001 |
| 糖尿病视网膜病变［例（%）］ | 61（57.01） | 14（43.75） | 21（6.10）ab | 145.064 | <0.001 |
表2 肾活检患者糖尿病肾脏疾病相关因素的Logistic回归分析（n=483） |
| 影响因素 | 单因素分析 | 多因素分析 | ||
|---|---|---|---|---|
| OR （95% CI） | P值 | OR （95% CI） | P值 | |
| 性别（男/女） | 0.554（0.334～0.918） | 0.022 | 1.085（0.486～2.424） | 0.842 |
| 年龄（每增加1岁） | 0.989（0.973～1.006） | 0.203 | 0.977（0.947～1.008） | 0.150 |
| 体重指数（每增加1 kg/m2） | 0.905（0.847～0.967） | 0.003 | 0.946（0.849～1.054） | 0.946 |
| 糖尿病病史（每增加1年） | 1.183（1.131～1.238） | <0.001 | 1.130（1.057～1.208） | <0.001 |
| 糖尿病视网膜病变（是/否） | 20.396（11.372～36.583） | <0.001 | 12.185（5.331～27.849） | <0.001 |
| 24 h尿蛋白量（每升高1 g） | 1.113（1.015～1.219） | 0.022 | 1.064（0.910～1.244） | 0.435 |
| 尿红细胞计数（每增加1个/高倍镜） | 0.997（0.994～0.999） | 0.017 | 0.987（0.974～0.999） | 0.039 |
| 空腹血糖（每升高1 mmol/L） | 1.074（1.015～1.116） | 0.014 | 1.063（0.968～1.166） | 0.200 |
| 糖化血红蛋白（每升高1%） | 1.240（1.068～1.440） | 0.005 | 1.482（1.119～1.961） | 0.006 |
| 总胆固醇（每升高1 mmol/L） | 0.870（0.770～0.983） | 0.025 | 0.816（0.665～1.001） | 0.051 |
| 血红蛋白（每升高1 g/L） | 0.975（0.966～0.985） | <0.001 | 0.973（0.957～0.990） | 0.001 |
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http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cn441217-20221124-01144
金李：数据收集、数据分析及文章书写；王晓培、王志刚：数据分析指导和文章修订；兰平：病理指导；刘辉：数据收集；路万虹：研究方案制定、文章修订
感谢参与本研究患者的支持
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