肾移植术后糖尿病的发病率及丙型肝炎在其发病过程中的作用  

Role of C hepatitis on the morbidity of posttransplant diabetes mellitus in renal transplant recipients

作　　者：孙雯[1] 张磊[1] 唐雅望[1] 杜林栋[1] 田野[1] 

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京市100050

出　　处：《中国组织工程研究与临床康复》2007年第38期7529-7532,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:肾移植术后糖尿病已成为影响患者术后短期及长期存活率的一项严重并发症。总结肾移植术后糖尿病的发病率及独立危险因素,并分析丙型肝炎病毒感染在其发病过程中的可能作用。方法:选择2000-01/2004-01在首都医科大学附属北京友谊医院行肾移植,术后服用他克莫司的患者58例,均知情同意。实验分组:①预防组(n=15):移植术前处于术前免疫功能高危状态。他克莫司起始剂量为10～12μg/L。②治疗组(n=25):移植术后出现耐激素性排斥反应,需要抗体治疗。他克莫司起始剂量为10～15μg/L。③转换组(n=18):移植术后出现高血脂、顽固性高血压、慢性移植肾功能减退等情况,传统药物疗效欠佳,需将环孢霉素A转为他克莫司。他克莫司起始剂量为8～10μg/L。进行随访观察,分析3组患者服用他克莫司1年内出现的肾移植术后糖尿病的发病率及丙型肝炎病毒感染的发病率。结果:58例患者全部进入结果分析。①58例患者中肾移植术后糖尿病的发病率为12.08%,服用他克莫司后出现肾移植术后糖尿病的平均时间为52d;丙型肝炎病毒感染的发病率为15.52%,丙型肝炎病毒感染患者中肾移植术后糖尿病的发病率高于非丙型肝炎病毒感染患者(44.44%,6.12%,P=0.001)。②丙型肝炎的发病率3组间差异无显著性意义(P>0.05);预防组及治疗组移植术后糖尿病发病率显著高于转换组(20%,16%,0%,P<0.05)。③多变量统计分析结果显示,在肾移植术后2个月内服用他克莫司的患者,丙型肝炎病毒与他克莫司的剂量是导致肾移植术后糖尿病的独立危险因素;丙型肝炎病毒感染患者出现肾移植术后糖尿病的危险性比非丙型肝炎病毒感染患者高出8.3倍,他克莫司浓度每增加1μg/L,患者出现肾移植术后糖尿病的危险性将增加12%。结论:肾移植术后服用他克莫司的患者肾移植术后糖尿病的发病率与丙型肝炎病毒感染密切相AIM： Posttransplant diabetes mellitus （PTDM） has been recognized as one severe complication that affects the short- and long-term survival rates of patients after renal transplantation. This study is designed to assess the incidence and independent risk factors of PTDM, and analyze the possible action of hepatitis C virus （HCV） infection in patients on the onset of PTDM. METHODS： Between January 2000 and January 2004, 58 renal allograft recipients were enrolled from Beijing Friendship Hospital Affiliated to Capital Medical University, with their informed consents. They were administrated with FK506 postoperation and divided into three groups： （1）Prophylactic group （P group, n =15）： For patients at high risk of immunological function, FK506 target level： 10-12 μg/L.（2）Rescue group （R group, n =25）： Antibody treatment was required for patients appearing steroid-resistant rejection. FK506 target level： 10-15 μLg/L.（3）Conversion group （C group, n =18）： Conventional drug therapy was unsatisfactory in patients with hyperlipidemia, refractory hypertension and chronic allograft dysfunction. Target level of FK506 conversed from Cyclosporin： 8-10 μg/L. The incidence of PTDM within one year after the initiation of FK506 following renal transplantation and the prevalence of HCV infection were assessed. RESULTS： All the 58 patients were involved in the result analysis. （1）The overall incidence of FK506-associated PTDM was 12.08%. The onset of PTDM occurred at a mean of 52 days after the administration of FK506. The overall prevalence of HCV infection was 15.52%. The incidence of PTDM was significantly higher in HCV （＋） patients than in HCV （-） patients （44.44%, 6.12%, P =0.001 ）.（2）The prevalence of HCV infection was not significantly different among the three groups （P 〉 0.05）. The incidence of PTDM was significantly higher in the P and R groups than in the C group （20%, 16%, 0%, P〈 0.05）. （3）By multivariate statistical analysis, HCV

关 键 词：肾移植 糖尿病 C型肝炎样病毒属 器官移植 

分 类 号：R617[医药卫生—外科学]