中文摘要：

目的分析老年糖尿病肾病（diabetic nephropathy,DN）患者的临床、病理特征及预后情况。方法回顾性分析2005年3月至2017年3月在中日友好医院肾内科行肾穿刺活检病理诊断为DN且临床资料完整的25例老年患者,同时分析随访6-125个月的15例患者的预后情况。肾脏结局事件定义为肌酐倍增、需要维持性肾脏替代治疗、估算肾小球滤过率（estimated glomerular filtration rate,eGFR）〈15ml·min^-1·（1.73m^2）^-1或死亡。结果依据2010年美国肾脏病学会杂志发表的DN病理分型标准进行分型,25例老年DN患者中Ⅰ型1例（4%）,Ⅱa型2例（8%）,Ⅱb型6例（24%）,Ⅲ型16例（64%）,Ⅳ型0例。Ⅲ型与Ⅰ型＋Ⅱa型患者相比,eGFR明显偏低（P〈0.05）;Ⅱb型与Ⅰ型＋Ⅱa型患者相比,eGFR明显偏低（P〈0.05）。Ⅱb型与Ⅲ型患者eGFR相比,无统计学差异（P〉0.05）;Ⅲ型患者血红蛋白明显低于Ⅱb型患者（P〈0.05）。15例老年DN患者随访超过6个月,8例发生肾脏结局事件,其中2例死亡,4例因进展为终末期肾病接受维持性肾脏替代治疗,2例仅发生肌酐倍增但尚未发生终末期肾病。老年DN患者肾功能稳定的平均时间为35（23,47）个月,其中1、2、4年肾脏无事件累积生存率分别为84.8%、58.2%、31.1%。年龄、蛋白尿、血压、心脑血管疾病和他汀类药物与老年DN患者肾功能进展密切相关。结论老年DN患者肾功能进展较快,控制蛋白尿、血压和心脑血管疾病的发生是治疗的关键。

英文摘要：

Objective To analyze the clinicopathologic features and prognostic of elderly patients with diabetic nephropathy （DN）. Methods A retrospective analysis was done to evaluate the clinicopathological features of 25 elderly patients diagnosed as DN by renal biopsy from the Department of Nephrology of China-Japan Friendship Hospital from May, 2005 to May, 2017. The prognosis of 15 elderly patients who were followed up for 6-125 months after biopsy was analyzed. Kidney ending events were defined as creatinine multiplication; maintenance renal replacement therapy; eGFR 〈 15 ml·min^-1 ·（1.73 m^2）^-1or death. Results In these 25 elderly patients with DN, there was one ease of typeⅠ , 2 cases of typell a, 6 cases of typeⅡ b, 16 cases of type Ⅲ. eGFR in patients of class Ⅲ and Ⅱ b was significantly lower than in those of class Ⅰ ＋ Ⅱ a. Hemoglobin in patients of class Ⅲ was significantly lower than in those of class Ⅱb. Fifteen elderly patients with DN were followed up for more than 6 months, and 8 cases had kidney ending events, including 2 deaths, 4 cases of maintenance renal replacement therapy due to end-stage renal disease （ESRD）, 2 cases of ereatinine multiplication without ESRD. An average survival time of elderly DN patients without kidney events was 35 （23, 47） months, and 1-, 2- and 4-year kidney events-free cumulative survival rate was 84. 8%, 58. 2% and 31.1% respectively. Age, proteinuria, blood pressure, cardiovascular and cerebrovascular events and stains were closely related to renal function in elderly patients with DN. Conclusions Renal function failure progresses faster in elderly patients with DN. Controling the proteinuria, blood pressure and cardiovascular and cerebrovascular events is the key of treatment.