摘要目的 研究2型糖尿病患者中特发性膜性肾病(IMN)的临床预测指标及肾脏生存预后.方法 本回顾性研究连续纳入101例2型糖尿病合并IMN及96例糖尿病肾病(DN)患者.以DN作为对照,用Logistic回归分析2型糖尿病合并IMN诊断的潜在危险因素,用多因素COX回归比较两种肾病进入终末期肾病(ESRD)的风险.结果 多因素分析表明,在经肾脏穿刺确诊为IMN或DN的2型糖尿病患者中,年龄≥55岁、肾病综合征、估算肾小球滤过率(eGFR)＞ 60 ml· main-1· (1.73 m2)-1、糖尿病病程≤5年、无糖尿病视网膜病变与IMN独立相关.而在合并肾病综合征的上述患者中,年龄≥55岁、eGFR＞ 60 ml· main-1·(1.73 m2)-1、糖尿病病程≤5年及无糖尿病视网膜病变仍与IMN独立相关;且ROC分析显示,eGFR为65.5 ml· min-1·(1.73 m2)-1是鉴别IMN和DN的最佳界值.在2型糖尿病患者中,DN患者进入ESRD的风险是IMN患者的16.8倍. 结论 2型糖尿病疑诊IMN或DN患者中,年龄≥55岁、肾病综合征、eGFR＞ 60 ml· min-1·(1.73 m2)-1、糖尿病病程≤5年或糖尿病视网膜病变缺如可能更提示IMN而非DN;而且IMN患者的肾脏预后好于DN患者.

abstractsObjective To evaluate the predictive factors and renal outcomes of idiopathic membranous nephropathy (IMN) in patients with type 2 diabetes (T2DM).Methods In this retrospective study,clinical data of 101 IMN patients with T2DM and 96 patients with diabetic nephropathy (DN) were consecutively collected.Logistic regression was used to assess potential clinical factors indicating IMN and COX regression was employed to analyze risks of IMN in developing to endstage renal disease (ESRD),as compared with that of DN,in patients with T2DM.Results In a multivariate model,age ≥55 years old,presence of nephrotic syndrome,estimated glomerular filtration rate (eGFR) ＞ 60 ml · min-1 · (1.73 m2)-1,duration of diabetes≤5 years and absence of diabetic retinopathy,were associated with IMN,as compared with DN,in patients with T2DM.In T2DM patients presented with nephrotic syndrome,age≥55 years old,eGFR ＞ 60 ml· min1· (1.73 m2)-1,duration of diabetes≤5 years and absence of diabetic retinopathy,were also associated with IMN,as compared with DN.Receiver operating characteristic curve (ROC) showed eGFR 65.5 ml · min-1 · (1.73 m2) 1 was an optimal cutoff in differentiating DN and IMN.DN was associated with 16.8 times as high risk of incident ESRD as compared with IMN in T2DM patients.Conclusions In patients with T2DM,age≥55 years,presence of nephrotic syndrome,early stage of CKD,duration of diabetes≤5 years and absence of retinopathy,may indicate IMN rather than DN.T2DM patients with IMN have much better renal prognosis as compared with DN.