| Objective: By retrospectively analyzing the clinical data of patients with type 2 diabetes mellitus in this study,to distinguish non-diabetic renal disease(NDRD)from diabetic nephropathy(DN)by the clinical and histopathological features,to emphasize the necessity of renal biopsy for T2 D patients,to explore the relationship between diabetic microangiopathy and cardiovascular diseases(CVD),and to look for clinical predictors of the occurrence and development of diseases,so as to improve the quality of life of patients and improve renal outcomes.Method: This study was based on the medical records of 262 patients with T2 D who were confirmed by renal biopsy from October 2013 through October 2020 at nephrology dept of the Second Hospital of Jilin University.This study is divided into three parts according to the different study population and groups.(1)In the first part,a total of 262 adult patients with T2 D were selected as the research objects and divided into three groups: isolated DN,isolated NDRD and DN combined with NDRD(MIX group).(2)In the second part,only patients diagnosed with diabetic nephropathy(DN)were selected as the research objects,and were grouped according to whether they were complicated with diabetic retinopathy(DR).(3)In the third part,DN patients were also taken as the research objects and grouped according to whether they were complicated with CVD.Collecting general clinical data,laboratory data,heart color ultrasound and ECG of all patients.SPSS 22.0 statistical software was used for analysis,and the relevant statistical analysis was carried out according to the corresponding statistical methods.Results: 1.There were 262 T2 D patients in this study who met the inclusion criteria,87(33.21%)in the isolated DN group,120(45.80%)in the isolated NDRD group,and 55(20.99%)in the MIX group.The most common pathologic type in NDRD patients with or without DN was membranous nephropathy(66 cases,37.71%),followed by Ig A nephropathy(25 cases,14.29%).2.Smoking habit,prevalence of DR,duration of diabetes,mean arterial pressure,systolic blood pressure,diastolic blood pressure,blood urea nitrogen(BUN),serum creatinine(Scr),Cystatin C(Cys C),hemoglobin(Hb),Estimated glomerular filtration rate(e GFR),Homocysteine(Hcy),brain natriuretic peptide(BNP),cardiac Troponin I(c Tn I),creatine kinase(CK),lactate dehydrogenase(LDH),alpha-hydroxybutyric dehydrogenase(α-HBDH)and prevalence of CVD of isolated DN group,isolated NDRD group and Mix group were significantly different(p < 0.05).3.Univariate logistic regression analysis was used to identify the significant variables for predicting NDRD in patients with type 2 diabetes mellitus complicated with renal disease: DR,duration of diabetes≤5 years,mean arterial pressure,BUN,Scr,Cys C,Hcy,Hb,e GFR,BNP,CK,α-HBDH,prevalence of CVD.Multivariate Logistic regression analysis showed that the risk factors for NDRD in patients with type 2 diabetes mellitus complicated with renal disease were absence of DR,duration of diabetes≤5 years,lower Hcy,and higher Hb,which helped us to distinguish DN from NDRD.4.The prevalence of DR in patients in isolated DN group is 41.38%.Patients in DN+DR group were younger than those in DN non-DR group,and the Cys C was higher,the difference was statistically significant(p< 0.05).The prevalence of CVD in DN+DR group was slightly higher than that in DN non-DR group,but the difference was not statistically significant(p> 0.05).5.The prevalence of CVD in patients in isolated DN group is high(51.72%),and we take that patients with DN whether to complicate with CVD as a dependent variable for univariate logistic regression analysis.As a result that age,duration of diabetes,BUN,BNP,LDH,α-HBDH were taken as independent variables into the multivariate Logistic regression model.The results showed that advanced age,longer duration of diabetes,higher BNP were the independent risk factors of DN patients with CVD.Conclusion: 1.Patients with type 2 diabetes mellitus complicated with renal disease are likely to develop NDRD,and the most common pathological type is membranous nephropathy,followed by Ig A nephropathy.It is recommended that patients with T2 D with signs of NDRD should undergo renal biopsy to determine the pathological type of kidney disease.2.Patients with DN have a higher prevalence of DR,and patients with DN combined with DR have an increased risk of CVD.At the same time,DR patients are getting younger,therefore,early screening of DR is of great significance for DN patients,furthermore,Cys C are effective predictors of the occurrence of DR.3.The prevalence of CVD in patients with DN is high,and the level of myocardial enzyme is generally high.Advanced age,longer duration of diabetes and higher BNP were independent risk factors for DN patients with CVD. |
