关键词: 肾小球病, 微小病变性, 糖尿病, 2型, 微小病变性肾病, 预后, 临床病理特点

Abstract: Background　In recent years，type 2 diabetes（T2DM）incidence is increasing in the young population，and minimal change disease（MCD）combined with T2DM is becoming less uncommon clinically.But the clinical and pathological characteristics and prognosis of MCD with T2DM are still unclear.Objective　To analyze the clinical and pathological characteristics and prognosis of patients with MCD combined with T2DM.Methods　Participants with renal biopsy-confirmed MCD were recruited from Department of Nephrology，the First Affiliated Hospital of Zhengzhou University during from June 1，2017 to June 1，2018，including 20 with MCD and T2DM（MCD with T2DM group），and 100 with MCD（MCD group）from 306 with simple MCD using a random number table generated by the SPSS 22.0.The clinicopathological and follow-up data of all patients（follow up from the first renal biopsy to recurrence or to June 2019）were collected，and clinical manifestations，pathological characteristics and prognosis were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to explore the independent risk factors of MCD with T2DM.Log-rank test was used to compare the cumulative complete remission rate and cumulative relapse-free survival rate of MCD and MCD with T2DM groups.Results　Compared with the MCD group，the median age，systolic blood pressure（SBP），fasting blood glucose，serum glycosylated hemoglobin（HbA1c），albumin（ALB）and serum IgG levels and prevalence of hypertension were higher，and male ratio，median levels of total cholesterol（TC），high-density lipoprotein（HDL），low-density lipoprotein（LDL）erythrocyte sedimentation rate（ESR），and 24-hour quantitative proteinuria were lower in MCD with T2DM group（P<0.05）.Moreover，MCD with T2DM group also showed higher rates of having higher severity of vascular injury and renal tubular atrophy，and higher prevalence of renal interstitial fibrosis，renal interstitial inflammation and glomerular sclerosis（P<0.05）.Univariate Logistic regression analysis showed that sex〔OR=5.108，95%CI（1.717，15.200）〕，age〔OR=1.068，95%CI（1.006，1.133）〕，hypertension〔OR=6.000，95%CI（1.982，18.165）〕，HbA1c〔OR=84.019，95%CI（12.465，566.317）〕，ALB〔OR=1.173，95%CI（1.100，1.250）〕，TC〔OR=0.730，95%CI（0.619，0.861）〕，ESR〔OR=0.978，95%CI（0.960，0.996）〕，24-hour quantitative proteinuria〔OR=0.818，95%CI（0.705，0.948）〕，IgG〔OR=1.568，95%CI（1.288，1.908）〕，prevalence of glomerular sclerosis〔OR=13.286，95%CI（4.142，42.614）〕，the severity of vascular injury，renal tubular atrophy and interstitial fibrosis〔OR=17.000，95%CI（4.833，59.794）〕 and renal interstitial inflammation〔OR=10.111，95%CI（2.684，38.087）〕were associated with MCD combined with T2DM（P<0.05）.Multivariate logistic regression analysis showed that IgG level〔OR=1.476，95%CI（1.190，1.831）〕and the severity of vascular injury and renal interstitial fibrosis〔OR=12.433，95%CI（2.032，76.065）〕were associated with MCD combined with T2DM（P<0.05）.Log-rank test showed that the cumulative complete remission rate of MCD with T2DM group was significantly lower than that of MCD group（P=0.027）.However，there was no significant difference in cumulative relapse-free survival rate of between the two groups（P=0.318）.Conclusion　Compared with the MCD group，the clinical manifestations of MCD with T2DM group are relatively slighter，but the pathological manifestations are more serious，which indicates the importance of renal biopsy by clinicians.Renal interstitial fibrosis，severe vascular injury，and elevated IgG level are risk factors for MCD combined with T2DM.The prognosis of MCD combined with T2DM is poor.

Key words: Glomerulopathy, minimal change；Diabetes mellitus, type 2；Minimal change disease；Prognosis；Clinicopathologic characteristics