在2型糖尿病中非糖尿病性脏疾病:从脏活检到精准医学
Sreenath Sreedharan1, Mohandas M K1, Vismaya K B2
1Nephrology, Government Medical College, Thiruvananthapuram, IND.
Cureus
|February 6, 2026
概括
非糖尿病性病 (NDKD) 影响到2型糖尿病患者的一半. 早期识别和量身定制的治疗,将脏保护与免疫调节结合起来,对于更好的结果至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 内分泌学 在内分泌学.
- 糖尿病学 糖尿病学
背景情况:
- 非糖尿病性病 (NDKD) 是2型糖尿病 (T2DM) 的一个显著而被低估的并发症.
- 有证据表明,T2DM患者的大部分病不仅仅是糖尿病病,还包括非糖尿病或混合病理.
- 这挑战了传统的观点,即糖尿病中的病始终是糖尿病的起源.
研究的目的:
- 审查目前关于T2DM中NDKD的流行,预测因素,诊断和治疗方法的证据.
- 强调将保护疗法与疾病特异性免疫调节相结合的重要性.
- 以指导临床实践在T2DM的背景下管理NDKD.
主要方法:
- 从PubMed,EMBASE和Scopus (2020年1月至2024年12月) 的文献进行叙述性审查.
- 包括系统性审查,元分析,RCT,队列研究和临床指南.
- 专注于T2DM中NDKD的患病率,临床预测因素,诊断工具和治疗策略.
主要成果:
- 在地理上,NDKD的患病率有所不同,亚洲常见的IgA脏病 (IgAN) 和西方人群中常见的膜性脏病 (MN) 和焦点细分性结核硬化 (FSGS).
- 关键预测因素包括糖尿病视网膜病变的不存在,糖尿病持续时间短,血和快速的eGFR下降.
- 新兴的诊断工具,如尿蛋白学和人工智能辅助组织病理学,显示出有希望的结果,但不能取代脏活检. 保护剂 (SGLT2i,GLP-1 RA,MRA) 和特定免疫调节 (例如,MN的修复剂) 是至关重要的.
结论:
- NDKD影响T2DM患者中三分之一到一半的脏病患者,需要从假设糖尿病脏病是唯一的原因转变.
- 综合管理将标准脏保护 (SGLT2i,RAS阻断,GLP-1 RA,MRA) 与组织学引导的免疫抑制相结合是必不可少的.
- 当诊断结果可以改变管理时,应该考虑脏活检,并且通过量身定制的治疗早期识别NDKD是改善患者结果的关键.
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