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目的:分析糖尿病肾病合并非糖尿病肾病的临床病理特点。方法:选取我院肾内科收治的临床诊断为糖尿病肾病的患者56例,肾脏穿刺进行肾脏活体组织检查,通过病理诊断将患者分为两组,分别为糖尿病肾病组和糖尿病肾病合并非糖尿病肾病组,比较两组患者的糖尿病病程、糖化血红蛋白、血压、血肌酐、血尿素氮、血尿酸、血清白蛋白、尿蛋白定量、血尿、视网膜病变。结果:经肾脏组织活检,56例患者中NDRD患者24例(42.9%),DN患者32例(57.1%);对24例NDRD患者进行病理类型分类,其中Ig A肾病33.0%,膜性肾病25.0%、系膜增生性肾小球肾炎20.2%、高血压肾损害8.3%、微小病变4.2%、局灶节段硬化性肾炎4.2%、新月体性肾小球肾炎4.2%。与DN组比较,NDRD组糖尿病病程、糖化血红蛋白、血尿、视网膜病变均有差异(P<0.05);而血肌酐、血尿素氮、血尿酸、血清白蛋白、尿蛋白定量均无明显差异(P>0.05)。结论:临床诊断的糖尿病肾病患者中有很大一部分实际上为糖尿病肾病合并非糖尿病肾病,且以Ig A型肾病比较多见,糖尿病病程、糖化血红蛋白、血尿、视网膜病变对鉴别二者具有一定的指导意义。
Objective: To analyze the clinicopathological features of diabetic nephropathy with non-diabetic nephropathy. Methods: Fifty-six cases of diabetic nephropathy clinically diagnosed as nephrology in our hospital were enrolled in this study. Kidney puncture was performed for the examination of renal biopsy. The patients were divided into two groups according to pathological diagnosis: diabetic nephropathy group and diabetic nephropathy combined with non-diabetic nephropathy group The duration of diabetes, glycosylated hemoglobin, blood pressure, serum creatinine, blood urea nitrogen, serum uric acid, serum albumin, urinary protein, hematuria and retinopathy were compared between the two groups. Results: Twenty-four cases (42.9%) of NDRD patients and 32 cases (57.1%) of DN patients were detected in 56 patients. The pathological classification of 24 patients with NDRD were 33.0% for IgA nephropathy and 25.0% for membranous nephropathy %, Mesangial proliferative glomerulonephritis 20.2%, hypertensive renal damage 8.3%, minimal change 4.2%, focal seglexulocytosis 4.2%, crescentic glomerulonephritis 4.2%. Compared with DN group, the duration of diabetes, glycosylated hemoglobin, hematuria and retinopathy in NDRD group were significantly different (P <0.05), while there was no significant difference in serum creatinine, blood urea nitrogen, serum uric acid, serum albumin and urinary protein > 0.05). Conclusion: A large part of clinically diagnosed patients with diabetic nephropathy is actually diabetic nephropathy with non-diabetic nephropathy, and Ig A nephropathy is more common. Diabetes mellitus, glycosylated hemoglobin, hematuria, and retinopathy have certain Guiding significance.