·糖尿病临床研究·

　　作者单位：315040宁波市医疗中心李惠利医院肾内科(沈洲姬);310016浙江大学医学院附属邵逸夫医院肾内科(李华、叶有新、胡卫民、冯剑、蒋欣欣、陆明晰)

　　2型糖尿病合并非糖尿病肾病的研究

　　沈洲姬 李华 叶有新 胡卫民 冯剑 蒋欣欣 陆明晰

　　【摘要】目的探讨T2DM合并非糖尿病肾病(NDKD)的相关因子，常见病理类型以及治疗经验。方法根据病理类型将56例T2DM患者分为NDKD组， DN组及合并组。比较3组患者各项临床资料。结果56例患者中NDKD发病率为58.9%，最常见病理类型为IgA肾病。相比于DN组及合并组，NDKD组糖尿病病程较短，DR发生率较低，蛋白尿量和HbA1c值较小。NDKD组及合并组共有11例患者接受免疫抑制剂治疗，4例效果较好。结论T2DM患者合并NDKD的机率较高，对于糖尿病病程较短，无DR的患者，应尽可能行肾活检明确诊断。对于T2DM合并NDKD患者，尤其是表现为肾病综合征者，可考虑给予免疫抑制剂的治疗，轻微病变型治疗效果相对较好。

　　【关键词】糖尿病肾病;非糖尿病肾病;病理类型

　　doi:10.3969/j.issn.1006-6187.2012.05.012

　　Study on the non-diabetic kidney disease in type 2 diabetes mellitusSHEN Zhou-ji, LI Hua, YE You-xin, et al. Department of Nephrology, Ningbo Lihuili Hospital, Ningbo 315040, China

　　【Abstract】ObjectiveTo investigate the related factors and renal histological lesions of non-diabetic kidney disease(NDKD) in T2DM patients.MethodsFifty-six T2DM patients with nephropathy were divided into three groups: NDKD group, diabetic nephropathy(DN) group, and NDKD + DN group. Various clinical date of the 3 groups were compared.ResultsOf the 56 patients, the incidence of NDKD accounted for 58.9%, and the most common pathological lesion was IgA nephropathy. Compared with the DN group and NDKD + DN group, the DM duration was shorter, the incidence of retinopathy was lower, the volume of proteinuria was less, and the value of HbA1c was smaller in the NDKD group. In the NDKD group and NDKD + DN group, there were 11 cases receiving immunosuppressive therapy and 4 of them showed an effective result.ConclusionConsidering the high prevalence of NDKD in T2DM patients, renal biopsy may be recommended for those who have shorter DM duration and are without retinopathy. Immunosuppressive therapy could be applied to the T2DM patients with NDKD, especially with the nephrotic syndrome.

　　【Key words】Diabetic nephropathy(DN); Non-diabetic kidney disease(NDKD); Pathological type