Page 88 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第45卷第6期
·826 · Journal of Nanjing Medical University（Natural Sciences） 2025年6月

·临床研究·

肾脏慢性病变评分在糖尿病肾脏病患者预后评估中的价值

师 颖，袁杨刚，张承宁，毛慧娟，段俗言 ，张 波 *
*
南京医科大学第一附属医院肾内科，江苏 南京 210029

［摘 要］ 目的：探讨肾脏慢性病变评分在糖尿病肾脏病（diabetic kidney disease，DKD）患者预后评估中的应用价值，并与传
统的DKD国际肾脏病理学会研究委员会（Research Committee of the Renal Pathology Society，RPS）病理分级进行比较。方法：对
2014年1月—2020年9月在南京医科大学第一附属医院肾内科住院并行肾穿刺活检病理确诊为DKD的129例患者进行回顾
性分析。根据肾脏慢性病变评分将患者分为轻微组（n=34）、轻度组（n=50）和中⁃重度组（n=45），比较各组患者的临床资料及病
理指标，并与DKD RPS病理分级进行比较。采用Cox回归分析肾脏不良预后的影响因素，Kaplan⁃Meier生存曲线比较无肾脏终
点事件和复合心血管事件的累积生存率，并通过受试者工作特征（receiver operating characteristic，ROC）曲线分析肾脏慢性病
变评分及其与估算的肾小球滤过率（estimated glomerular filtration rate，eGFR）、24 h 尿蛋白联合在肾脏预后评估中的诊断价
值。结果：肾脏慢性病变评分较高的患者肾功能更差、贫血更明显，DKD RPS病理分级更高。Kaplan⁃Meier 生存曲线显示，肾
脏慢性病变评分较高的患者无肾脏终点事件的累积生存率显著降低，预后更差（P < 0.05）。Cox回归分析显示，高肾脏慢性病
变评分是肾脏终点事件的独立危险因素（P < 0.05）。ROC曲线分析显示，肾脏慢性病变评分的诊断价值略低于DKD RPS病理
分级［曲线下面积（area under the curve，AUC）：0.651 vs. 0.875］，但两者之间的差异无统计学意义。联合 eGFR 和 24 h 尿蛋白
后，肾脏慢性病变评分的AUC值提高至0.810。结论：DKD患者的高肾脏慢性病变评分与更显著的肾功能损害相关，是肾脏不
良预后的独立危险因素，联合临床指标（如eGFR和24 h尿蛋白）能显著提高预后评估的准确性。
［关键词］ 糖尿病肾病；RPS病理分级；肾脏慢性病变评分；预后
［中图分类号］ R692.9；R587.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2025）06⁃826⁃12
doi：10.7655/NYDXBNSN241367

Significance of the total renal chronicity score in predicting outcome of patients with
diabetic kidney disease
* *
SHI Ying，YUAN Yanggang，ZHANG Chengning，MAO Huijuan，DUAN Suyan ，ZHANG Bo
Department of Nephrology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：This study aimed to evaluate the prognostic value of the renal chronicity score in patients with diabetic kidney
disease（DKD）and compare it with the traditional DKD Research Committee of the Renal Pathology Society（RPS）pathological
classification. Methods：Clinical and pathological data from 129 patients diagnosed with DKD through renal biopsy at the First
Affiliated Hospital of Nanjing Medical University between January 2014 and September 2020 were retrospectively analyzed. Based on
the renal chronicity score，patients were categorized into three groups：minimal（n=34），mild（n=50），and moderate⁃severe（n=45）. The
clinical characteristics and pathological indicators of each group were compared，and these results were evaluated against the DKD
RPS pathological classification. The Cox regression analysis was used to identify factors influencing poor renal outcomes. The Kaplan⁃
Meier survival curves were employed to compare cumulative renal event⁃free survival rates，and the receiver operating characteristic
（ROC）curve analysis was performed to assess the diagnostic value of the renal chronicity score，both alone and in combination with
estimated glomerular filtration rate（eGFR）and 24⁃hour urinary protein to predict renal outcomes. Results：Patients with higher renal
chronicity scores exhibited more severe renal dysfunction，greater anemia，and higher pathological grades according to the DKD RPS
pathological classification. The Kaplan ⁃ Meier’s survival analysis showed that patients with higher renal chronicity scores had

［基金项目］ 白求恩·普爱医学研究基金项目（PAYJ⁃058）；北京融和医学发展基金会（KYS2021⁃03⁃02⁃14）
通信作者（Corresponding author），E⁃mail：duansuyan@jsph.org.cn（ORCID：0009⁃0003⁃6529⁃3801）；zhangbo@jsph.org.cn（ORCID：
∗
0000⁃0002⁃6902⁃9093）