联合肾小球基底膜和肾小管基底膜评估可提高对糖尿病终末期肾病的预测能力。

Combining glomerular basement membrane and tubular basement membrane assessment improves the prediction of diabetic end-stage renal disease.

机构信息

Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.

Division of General Practice, West China Hospital of Sichuan University, Chengdu, China.

出版信息

J Diabetes. 2021 Jul;13(7):572-584. doi: 10.1111/1753-0407.13150. Epub 2021 Jan 5.

DOI:10.1111/1753-0407.13150

PMID:33352010

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8246816/

Abstract

BACKGROUND

To address the prognostic value of combining tubular basement membrane (TBM) and glomerular basement membrane (GBM) thickness in diabetic nephropathy (DN).

METHODS

This retrospective study enrolled 110 patients with type 2 diabetes and biopsy-proven DN from 2011 to 2018. The pathological findings were confirmed according to the Renal Pathology Society classifications. GBM and TBM thicknesses were determined using the Haas' direct measurement/arithmetic mean method and orthogonal intercept method, respectively. Cox proportional hazard models were used to investigate the hazard ratios (HRs) for the influence of combined GBM and TBM thickness for predicting end-stage renal disease (ESRD).

RESULTS

Patients were assigned to three groups according to the median GBM and TBM thickness: GBM TBM (GBM < 681 nm and TBM < 1200 nm), GBM TBM /GBM TBM (GBM ≥ 681 nm and TBM < 1200 nm, or GBM < 681 nm and TBM ≥ 1200 nm), and GBM TBM (GBM ≥ 681 nm and TBM ≥ 1200 nm). The GBM TBM /GBM TBM and GBM TBM groups displayed poorer renal function, a more severe glomerular classification and interstitial inflammation, and poorer renal survival rates than the GBM TBM group The GBM TBM /GBM TBM and GBM TBM groups had adjusted HRs of 1.49 (95% confidence interval [CI], 1.21-9.75) and 3.07 (95% CI, 2.87-12.78), respectively, compared with the GBM TBM group.

CONCLUSIONS

TBM thickness enhanced GBM thickness for renal prognosis in patients with type 2 diabetes.

摘要

背景

探讨联合管基底膜（TBM）和肾小球基底膜（GBM）厚度在糖尿病肾病（DN）中的预后价值。

方法

本回顾性研究纳入了 2011 年至 2018 年间 110 例经活检证实的 2 型糖尿病合并 DN 患者。病理发现根据肾脏病理学会分类标准确定。使用 Haas 直接测量/算术平均值法和正交截距法分别确定 GBM 和 TBM 厚度。Cox 比例风险模型用于研究联合 GBM 和 TBM 厚度对预测终末期肾病（ESRD）的影响的风险比（HR）。

结果

根据 GBM 和 TBM 厚度中位数将患者分为三组：GBM TBM（GBM<681nm 且 TBM<1200nm）、GBM TBM/GBM TBM（GBM≥681nm 且 TBM<1200nm，或 GBM<681nm 且 TBM≥1200nm）和 GBM TBM（GBM≥681nm 且 TBM≥1200nm）。GBM TBM/GBM TBM 和 GBM TBM 组的肾功能较差，肾小球分级和间质炎症更严重，肾脏生存率较 GBM TBM 组差。GBM TBM/GBM TBM 和 GBM TBM 组的调整 HR 分别为 1.49（95%置信区间 [CI]，1.21-9.75）和 3.07（95% CI，2.87-12.78），与 GBM TBM 组相比。