肝移植后糖尿病的病因分析  

Pathogenetic analysis of diabetes mellitus after liver transplantation

作　　者：刘亚力[1] 王立祥[2] 徐春[1] 朱晓丹[3] 

机构地区：[1]武警总医院内分泌科,北京100039 [2]武警总医院重症监护病房,北京100039 [3]武警总医院肝移植中心,北京100039

出　　处：《武警医学》2005年第6期411-413,共3页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的通过对94例肝移植患者术前和术后各项糖代谢指标的观察,了解移植后糖尿病的发病率和发病机理。方法94例肝移植患者分别于术前和术后3个月行75g葡萄糖耐量试验。抽取空腹血测定血糖、胰岛素、胰岛素原、血脂和肝功有关的各项指标。计算胰岛素抵抗指数(Insulinresistanceindex,IRI)。结果94例术前糖耐量正常患者术后3个月经过口服葡萄糖耐量实验(Oralglucosetolerancetest,OGTT)分为3组:糖耐量正常组(Normalglucosetolerance,NGT)41例(44%),糖耐量减低组(Impairedglucosetolerance,IGT)37例(39%)和移植后糖尿病组(Posttransplantationdiabetesmellitus,PTDM)16例(17%)。3组所用类固醇激素和他克莫斯的剂量相等。移植前IGT组和PTDM组的空腹和餐后2h血糖以及胰岛素原明显高于NGT组,PTDM组的空腹胰岛素明显低于NGT组,胰岛素原/胰岛素PTDM组明显高于NGT组。3组的IRI无明显差异。术后3个月以体重增加3%为标准将患者分组,体重增加组中的PTDM组的IRI明显高于NGT组。结论移植前空腹和餐后2h血糖,以及胰岛素原与胰岛素的比值可预测移植后糖尿病的发生与否。β细胞功能异常是主要发病机制,术前β细胞功能和胰岛素敏感性的检查可预测移植术后是否发生糖尿病。Objective To investigate the pathogenesis and possible risk factors for diabetes mellitus (DM) after liver transplantation.Methods Oral glucose tolerance test(OGTT) and insulin-released test were carried out in 94 patients with normal glucose tolerance (NGT) 1 week before and 3 months after liver transplantation.Fasting blood glucose,insulin,proinsulin, lipids,and liver function indices were determined to calculate insulin resistance indes.Results The subjects were classified into three groups according the criteria of WHO on OGTT after transplantation: (a) 41 patients (44%)with normal glucose tolerance(NGT); (b)37 patients(39%) with impaired glucose tolerance (IGT); and (c) 16 patients(17%) with posttransplantation diabetes mellitus(PTDM). Dosages of steroid and acrolimus were identical among the three groups. Before transplantation , the fasting and 2-hr glucose , proinsulin /insulin ratios were significantly higher in the IGT and PTDM groups than in the NGT group, but the insulin resistance index was not significantly different between the three groups. In addition, the fasting insulin was significantly lower in the PTDM group than in the NGT group.Conclusions Fasting and 2-hr plasma glucose level , and proinsulin/insulin ratio before transplantation are probable indicators of β-cell dysfunction and may be predictors for the development of PTDM. Furthermore , β-cell dysfunction , rather than insulin resistance, was proven to be the main factor for the pathogenesis of PTDM.

关 键 词：糖尿病 移植后 病因分析 餐后2h血糖 葡萄糖耐量试验 胰岛素抵抗指数 葡萄糖耐量实验 β细胞功能异常 肝移植患者 胰岛素原 PTDM 胰岛素敏感性 体重增加 糖代谢指标 index 糖耐量正常 糖耐量减低 类固醇激素 空腹胰岛素 

分 类 号：R587.1[医药卫生—内分泌] R457.7[医药卫生—内科学]