■在临床实践中,部分患者通过肾活检诊断为糖尿病肾病(DN)合并急性肾小管间质性肾炎(ATIN)。对这类病人的治疗和预后的研究相对较少,对于使用糖皮质激素进行治疗尚无共识。因此,我们的研究探讨了DN联合ATIN的进展以及糖皮质激素治疗后的肾脏结局.
■本研究回顾性分析了2015年1月1日至2021年12月31日在本中心通过肾活检诊断为DN合并ATIN的患者。我们收集了一般患者信息,实验室指标,肾脏病理指标,和肾活检后糖皮质激素的使用。从医疗记录中收集随访数据。统计分析方法包括t检验,非参数检验,和卡方检验。单因素和多因素Cox回归分析用于评估患者肾脏终点事件的危险因素。统计显著性定义为p值<0.05。
■在这项研究中,共纳入67例患者.根据是否接受糖皮质激素治疗将受试者分为两组:类固醇组33例,非类固醇组34例。在类固醇组中,19例患者达到肾脏终点事件,显著高于非类固醇组(57.58%vs.29.41%,p=0.038)。单因素Cox回归分析显示血肌酐(HR=1.008,p<0.001),白蛋白(HR=0.919,p<0.001),24小时尿蛋白(HR=1.093,p=0.002),血红蛋白(HR=0.964,p=0.001),甘油三酯(HR=1.12,p=0.04),糖皮质激素(HR=2.507,p=0.019)是DN合并ATIN患者肾脏终点事件的影响因素。多因素Cox回归分析显示,白蛋白(HR=0.863,p=0.003)是DN合并ATIN患者发生肾脏终点事件的独立危险因素。
■使用糖皮质激素治疗并不能改善DN合并ATIN患者的肾脏预后。白蛋白水平较低与肾脏预后较差相关。
UNASSIGNED: In clinical practice, some patients are diagnosed with diabetic nephropathy (DN) combined with acute tubulointerstitial nephritis (ATIN) through renal biopsy. There is relatively little research on the treatment and prognosis of such patients, and no consensus exists on the use of glucocorticoid for treatment. Therefore, our study explores the progression of DN combined with ATIN and the renal outcomes after treatment with glucocorticoid.
UNASSIGNED: This study retrospectively analyzed patients diagnosed with DN combined with ATIN through renal biopsy at our center from January 1, 2015, to December 31, 2021. We collected general patient information, laboratory indicators, renal pathology indicators, and the glucocorticoid usage after kidney biopsy. Follow-up data were collected from medical records. Statistical analysis methods included t-tests, non-parametric tests, and chi-square tests. Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for renal endpoint events in patients. Statistical significance was defined as p-values < 0.05.
UNASSIGNED: In this study, a total of 67 patients were included. The subjects were divided into two groups based on whether they received glucocorticoid treatment: 33 patients in the steroid group and 34 in the non-steroid group. In the steroid group, 19 patients reached the renal endpoint event, which was significantly higher than in the non-steroid group (57.58% vs. 29.41%, p = 0.038). Univariate Cox regression analysis showed that serum creatinine (HR = 1.008, p < 0.001), albumin (HR = 0.919, p < 0.001), 24-h urinary protein (HR = 1.093, p = 0.002), hemoglobin (HR = 0.964, p = 0.001), triglycerides (HR = 1.12, p = 0.04), and the use of glucocorticoid (HR = 2.507, p = 0.019) were influencing factors for renal endpoint events in patients with DN combined with ATIN. Multivariate Cox regression analysis showed that albumin (HR = 0.863, p = 0.003) was an independent risk factor for renal endpoint events in patients with DN combined with ATIN.
UNASSIGNED: The use of glucocorticoid in treatment does not improve renal prognosis in patients with DN combined with ATIN. Lower levels of albumin are associated with a worse renal prognosis.