Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.
Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, Regenerative Medicine Research Center, Chengdu, 610041, China.
Acta Diabetol. 2018 Jul;55(7):669-679. doi: 10.1007/s00592-018-1128-9. Epub 2018 Apr 2.
Glomerular basement membrane (GBM) thickening is considered as one of the earliest detectable pathological features of diabetic nephropathy (DN). However, whether the thickness of GBM will impact the prognosis of DN remains largely unknown. Our aim was to explore the relationship between thickness of GBM and DN progression in patients with type 2 diabetes mellitus (T2DM).
A total of 118 patients with T2DM and biopsy-proven DN who received follow-up for at least 1 year were recruited. The patients were divided into two groups according to the median (787 nm) of the GBM thickness: Group 1: GBM thickness < 787 nm (n = 59), and Group 2: GBM thickness ≥ 787 nm (n = 59). The GBM width was estimated by the direct GBM measurements as recently modified by Haas. Renal outcomes were defined by progression to ESRD and/or doubling of serum creatinine (D-Cr). The influence of GBM thickness on renal outcomes was assessed using Cox regression.
Compared with the Group 1, patients in Group 2 had more serious renal insufficiency and glomerular lesions. During the follow-up, ESRD occurred in 39.8% of patients, and 8.5% of patients progressed to D-Cr. The univariate analysis indicated the greater width of GBM the higher risk of renal outcomes in T2DM patients with DN (HR [95% CI] = 2.180 [1.246-3.814], p = 0.006). However, the multivariate COX analysis demonstrated that the GBM thickness was not an independent risk factor for progression to ESRD or D-Cr (HR [95% CI] = 0.825 [0.404-1.685], p = 0.597) when adjusting for important clinical variables and pathological findings.
In conclusion, the DN patients with greater width of GBM had relatively poorer renal prognosis, although it did not emerge as an independent indicator of disease progression.
肾小球基底膜（GBM）增厚被认为是糖尿病肾病（DN）最早可检测到的病理特征之一。然而，GBM 的厚度是否会影响 DN 的预后仍知之甚少。我们的目的是探讨 2 型糖尿病（T2DM）患者 GBM 厚度与 DN 进展之间的关系。
共纳入 118 例经活检证实的 T2DM 并接受至少 1 年随访的患者。根据 GBM 厚度中位数（787nm）将患者分为两组：GBM 厚度<787nm 组（n=59）和 GBM 厚度≥787nm 组（n=59）。GBM 宽度由 Haas 最近修正的直接 GBM 测量估计。肾脏结局定义为进展至终末期肾病（ESRD）和/或血清肌酐倍增（D-Cr）。使用 Cox 回归评估 GBM 厚度对肾脏结局的影响。
与 GBM 厚度<787nm 组相比，GBM 厚度≥787nm 组患者的肾功能不全和肾小球病变更严重。随访期间，39.8%的患者发生 ESRD，8.5%的患者进展为 D-Cr。单因素分析表明，DN 患者 GBM 宽度越大，肾脏结局的风险越高（HR[95%CI] = 2.180[1.246-3.814]，p=0.006）。然而，多因素 COX 分析表明，调整重要临床变量和病理发现后，GBM 厚度不是进展为 ESRD 或 D-Cr 的独立危险因素（HR[95%CI] = 0.825[0.404-1.685]，p=0.597）。
总之，GBM 较宽的 DN 患者的肾脏预后较差，尽管它不是疾病进展的独立指标。
