Harris R D, Steffes M W, Bilous R W, Sutherland D E, Mauer S M
Department of Pediatrics, FHP Health Care, Marina Valley, California.
Kidney Int. 1991 Jul;40(1):107-14. doi: 10.1038/ki.1991.187.
We studied the lesions of global glomerular sclerosis and arteriolar hyalinosis in 43 (29 females) insulin-dependent diabetes mellitus (IDDM) patients whose creatinine clearance (CCr) was greater than or equal to 45 ml/min/1.73 m2 and whose renal biopsies had at least 20 glomeruli available for study. These patients, ages 17 to 55 years, had IDDM for 7 to 32 (20 +/- 6, means +/- SD) years. CCr ranged from 47 to 139 (91 +/- 25) ml/min/1.73 m2 and urinary albumin excretion (UAE) from 5 to 3386 (median = 127) mg/24 hrs. Eighteen patients were hypertensive. Thus, these patients represented a broad clinical range from normal renal function through overt diabetic nephropathy. The percent of glomeruli which were globally sclerosed was strongly correlated with CCr (r = -0.64, P less than 0.0001) and log UAE (r = +0.67, P less than 0.001). Hypertension was more common in patients with more than 10% sclerosed glomeruli (chi square = 9.5, P less than 0.002). Percent sclerosed glomeruli was highly significantly correlated with the index of severity of the arteriolar hyalinosis lesion (r = +0.66, P less than 0.0001) and mesangial volume fraction (r = +0.61, P less than 0.0001). We hypothesize that arteriolar hyalinosis could contribute to global glomerular sclerosis through severe compromise of glomerular blood flow. Alternately, global glomerular sclerosis may result from marked mesangial expansion and capillary occlusion. However, in this broad range of patients it appeared that global glomerular sclerosis and mesangial expansion were not infrequently independent diabetic renal lesions which could contribute separately to the ultimate development of overt diabetic nephropathy.
我们研究了43例（29例女性）胰岛素依赖型糖尿病（IDDM）患者的球性肾小球硬化和小动脉玻璃样变病变，这些患者的肌酐清除率（CCr）大于或等于45 ml/min/1.73 m2，且肾活检至少有20个肾小球可供研究。这些患者年龄在17至55岁之间，患IDDM 7至32（20±6，均值±标准差）年。CCr范围为47至139（91±25）ml/min/1.73 m2，尿白蛋白排泄量（UAE）为5至3386（中位数 = 127）mg/24小时。18例患者患有高血压。因此，这些患者代表了从肾功能正常到显性糖尿病肾病的广泛临床范围。球性硬化的肾小球百分比与CCr（r = -0.64，P < 0.0001）和log UAE（r = +0.67，P < 0.001）密切相关。高血压在硬化肾小球超过10%的患者中更为常见（χ2 = 9.5，P < 0.002）。硬化肾小球百分比与小动脉玻璃样变病变的严重程度指数（r = +0.66，P < 0.0001）和系膜体积分数（r = +0.61，P < 0.0001）高度显著相关。我们推测小动脉玻璃样变可能通过严重损害肾小球血流而导致球性肾小球硬化。或者，球性肾小球硬化可能源于明显的系膜扩张和毛细血管闭塞。然而，在这一广泛的患者群体中，球性肾小球硬化和系膜扩张似乎常常是独立的糖尿病肾脏病变，它们可分别促成显性糖尿病肾病的最终发展。
