肾移植术后糖尿病临床特点及相关危险因素分析  

The characteristics and risk factors for post-transplantation diabetes mellitus

作　　者：陈雄[1,2] 姚斌[1] 董婷婷[1] 陈立中[3] 邱江[3] 陈国栋[3] 翁建平[4] 

机构地区：[1]中山大学附属第一医院内分泌科,广州510080 [2]温州医学院附属第一医院内分泌科,325000 [3]中山大学附属第一医院器官移植中心,广州510080 [4]中山大学附属第三医院内分泌科

出　　处：《中华内科杂志》2009年第7期547-551,共5页Chinese Journal of Internal Medicine

摘　　要：目的了解肾脏移植术后糖尿病患者的临床特点及肾移植术后糖尿病的相关危险因素。方法收集1984年2月至2006年12月期间在中山大学附属第一医院器官移植中心接受肾移植手术术后患糖尿病患者的住院期间资料，分析肾移植术后糖尿病患者的临床特点及其相关危险因素。结果该期间行肾移植术患者1872例，肾移植术后住院期间新发糖尿病共344例，占18．4％，空腹血糖受损237例，占12．7％；免疫抑制剂方案的选择与肾移植术后糖尿病的发病率明显相关。经多因素回归分析发现，肾移植术后糖尿病的发病率随。肾移植时的年龄增高而增高（OR：1．309，P=0．049），术前高TG水平（OR：1．311，P=0．005）、高剂量甲泼尼龙（OR：1．239，P=0．011）和使用他克莫司（OR：1．522，P=0．008）是肾移植术后糖尿病发生的独立危险因素，吗替麦考酚酯（OR：0．716，P=0．028）和盐酸地尔硫革（OR：0．737，P=0．015）是肾移植术后糖尿病的保护因素。结论接受肾移植手术的患者住院期间肾移植术后糖尿病发病率高达18．4％；多种危险因素与肾移植术后糖尿病的发生有关，其中以免疫抑制剂的影响较明显。Objective To investigate the characteristics of post-transplantation diabetes mellitus and analyze its risk factors. Methods Extensive survey was carried out to understand the characteristics of post- transplantation diabetes mellitus in patients who received kidney grafting from February 1984 to December 2006. Results Three hundred forty-four post-transplantation diabetes mellitus patients from 1872 ones after kidney grafting were found from February 1984 to December 2006. The prevalence of new onset post- transplant diabetes mellitus and impaired fasting glucose in kidney allograft recipients were 18.4% and 12. 7% respectively, being significantly higher than that in general population and other inpatients. The options of immunosuppressants were significantly associated with the prevalence of post-transplantation diabetes mellitus. By multivariate logistic regression analysis, the baseline characteristics of the post transplantation diabetes mellitus patients were significantly associated with increased age（ OR： 1. 309, P = 0. 049）, elevated level of the triglyceride （ OR： 1. 311, P = 0. 005 ）, treatment with tacrolimus （ FK5C6 ） （ OR： 1. 522, P =0. 008）, and large dose of intravenous pulsed prednisolone（ OR： 1. 239, P = 0. 011 ）, as compared with patients without post-transplantation diabetes mellitus. Besides, the number of patients with at least one acute rejection episode was significantly greater in the post-transplantation diabetic patients. Mycophenolate mofetil （ OR： O. 716, P = 0. 028 ） and dihiazem （ OR： 0. 737, P = 0. 015 ） were associated with lower risk of post-transplantation diabetes melfitus. Conclusions High prevalence of abnormal glucose metabolism in renal allograft recipients during hospitalization was observed. Many risk factors contributed to the development of post transplantation diabetes mellitus.

关 键 词：糖尿病 肾移植 发病率 危险闪素 

分 类 号：R686[医药卫生—骨科学]