目的 总结和分析IgA肾病(IgAN)合并糖尿病患者临床病理改变特点.方法 收集2015年1月至2017年1月在郑州大学第一附属医院肾内科就诊,并经肾活检确诊的原发性IgAN患者500例的临床病理资料.按照是否合并糖尿病分为IgAN合并糖尿病组(n=25)和单纯IgAN组(n=475),比较两组患者临床病理改变的差异.用倾向值得分法匹配两组患者的临床及病理资料,比较匹配后两组患者电镜下基底膜厚度的差异.回顾性分析两组随访≥3个月患者的临床资料,Kaplan-Meier生存分析比较两组患者预后的差异.结果 与单纯IgAN组相比,IgAN合并糖尿病组患者年龄较大[(46.36±13.49)岁比(34.00±13.80)岁,P<0.001],血三酰甘油水平较高[2.06(1.52,3.11)mmol/L比1.51(1.01,2.25)mmol/L,P=0.012].IgAN合并糖尿病组肾小球基底膜厚度显著高于单纯IgAN组[(384.33±61.20)nm比(346.72±52.65)nm,P=0.044].与单纯IgAN组比较,IgAN合并糖尿病组患者发生终点事件比例更高[4/7(57.14%)比25/265(9.33%),P<0.001],预后更差(Log-Rank检验,P=0.004).结论 IgAN合并糖尿病较单纯IgAN患者具有不同的临床、病理特点和预后,此类患者更需密切监测病情和积极治疗.
Objective To sum up and analyze the clinical and pathological characteristics in patients with both IgA nephropathy (IgAN) and diabetes mellitus. Methods A total of 500 patients were recruited, including 25 patients with both IgAN and diabetes mellitus, and 475 patients with IgAN only, who were diagnosed by renal-biopsy during Jan 2015 to Jan 2017 at the First Affiliated Hospital of Zhengzhou University. The clinical and pathological data were collected and analyzed using SPSS 22.0. Propensity Score Matching was used to match and select the patients in the both groups, and thereafter the depth of the basement membrane from the matched patients were compared using electron microscopy. The data of the patients whose follow - up time was ≥3 months were retrospectively collected, and Kaplan-Meier analysis was used to compare the difference of the prognosis. Results Compared to the patients with IgAN only, patients with both IgAN and diabetes mellitus were older [(46.36±13.49) years vs (34.00±13.80) years, P<0.001], had higher level of serum triglyceride [2.06(1.52, 3.11) mmol/L vs 1.51(1.01, 2.25) mmol/L, P=0.012] and thicker basement membrane [(384.33 ± 61.20) nm vs (346.72 ± 52.65) nm, P=0.044]. The patients with both IgAN and diabetes mellitus were more prone to reach the composite endpoint [4/7(57.14%) vs 25/265(9.33%), P<0.001] and had worse prognosis (Log-Rank test, P=0.004). Conclusions IgAN patients with diabetes mellitus have different clinical, pathological characteristics and prognosis from patients with IgAN alone. These patients need to be closely monitored and actively treated.