Objective: To validate and compare the efficacy of two noninvasive diagnostic models for diabetic nephropathy (DN) based on diabetic retinopathy (DR).
Methods: A total of 565 patients with type 2 diabetes undergoing kidney biopsy in the Department of Nephrology, PLA General Hospital from January, 1993 to December, 2014 were studied. The patients were divided into DN group and non-diabetic nephropathy (NDRD) group according to renal pathological diagnosis. The data from the 22-year period were divided into 3 stages based on chronological order: early stage (from 1993 to 2003), middle stage (from 2004 to April, 2012), and late stage (from May, 2012 to December, 2014). The changes in clinical features and pathological diagnosis of the patients with renal biopsy over the 22 years were analyzed. The published DNT model and JDB model, both based on DR, were validated and compared for diagnostic effectiveness of DN, and the characteristics of the misdiagnosed cases were analyzed.
Results: The incidences of hypertension and DR and levels of glycosylated hemoglobin (HbA1c), creatinine and 24-h urinary protein were all significantly higher, while hemoglobin and triglyceride levels were lower in DN group than in NDRD group (P<0.05). The proportion of NDRD cases increased gradually over time, with IgA nephropathy and membranous nephropathy as the main pathological types. The AUC of JDB model was 0.946, similar to that of NDT model (0.925; P=0.198). The disease course of diabetes, hematuria and incidence of DR were important clinical features affecting the diagnostic accuracy of the models.
Conclusion: The clinical features and pathological diagnosis of DR change over time. The non-invasive diagnostic models based on DR have good diagnostic efficacy for DN.
目的: 验证和比较基于糖尿病视网膜病变(DR)的糖尿病肾病(DN)无创诊断模型的效能。
方法: 收集1993年1月~2014年12月在解放总医院肾脏病科行肾活检的2型糖尿病患者565例，以肾脏病理诊断为依据分为DN组及非糖尿病肾病(NDRD) 组。将22年间的数据按时间先后分为早期1993年~2003年，中期2004年~2012年4月，晚期2012年5月~2014年12月。明确22年间肾活检2型糖尿病患者的临床特征和病理诊断变迁。对国际已发表的基于DR的DN无创诊断模型(DNT模型和JDB模型)进行诊断效能的验证并比较优劣，分析误判病例的特点。
结果: DN组高血压、DR的发生率及糖化血红蛋白(HbA1c)、肌酐、24 h尿蛋白定量均高于NDRD组(P<0.05)，血红蛋白、甘油三酯、低于非糖尿病肾病组(P<0.01)。NDRD的比例逐渐上升，主要的病理类型为IgA肾病和膜性肾病。JDB模型AUC为0.946，NDT模型AUC为0.925，但两者差异无统计学意义(P=0.198)。糖尿病病史、血尿和DR发生率是影响模型误判的重要临床特征。
结论: DN的临床特征和病理诊断随时间发生变迁，基于DR的无创诊断模型对DN具有良好的诊断效能。
Keywords: diabetic nephropathy; diabetic retinopathy; diagnostic models.