肝移植术后三年及以上患者糖代谢异常情况及其发病机制初探  

Prevalence of abnormal glucose metabolism and preliminary investigation of its pathogenesis in patients being alive over 3 years after liver transplantation

作　　者：陈显英[1] 于明香[1] 周俭[2] 高键[3] 高鑫[1] 

机构地区：[1]复旦大学附属中山医院内分泌科,上海200032 [2]复旦大学附属中山医院肝外科,上海200032 [3]复旦大学附属中山医院循证医学中心,上海200032

出　　处：《中华内分泌代谢杂志》2011年第3期215-218,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的 评估肝移植术后3年及以上患者糖代谢异常情况,初步探讨移植后糖尿病的发病机制.方法 收集2001年4月至2008年12月在中山医院进行肝移植患者的临床资料,排除术前已确诊糖尿病、死亡及失访患者,对肝移植术后≥3年的199例患者完成随访,统计根据空腹血糖诊断的移植后糖尿病（PTDM）发生率;对肝移植≥3年且根据空腹血糖未达到糖尿病诊断标准的的32例患者进行口服75 g葡萄糖耐量试验（OGTT）,检测其空腹及糖负荷后2 h血糖和胰岛素,根据血糖情况分为血糖正常组、糖调节受损（IGR）组和PTDM组,计算其PTDM构成比和稳态模型评估（HOMA）指数.结果 肝移植术后≥3年的患者中,根据空腹血糖诊断的PTDM发生率为34.67%.对肝移植≥3年且根据空腹血糖未达到糖尿病诊断标准的32例患者进行OGTT得到：PTDM构成比为9.38%,IGR[包括空腹血糖受损和（或）糖耐量受损]为56.25%,血糖正常为34.37%.稳态模型评估胰岛β细胞功能指数（HOMA-β）在血糖正常组、IGR组、PTDM组依次递减,且PTDM组与血糖正常组、IGR组比较均有显著下降（均P＜0.01）.稳态模型评估胰岛素抵抗指数（HOMA-IR）在IGR组最高,PTDM组次之,IGR组相对血糖正常组升高有统计学意义.结论 本院肝移植≥3年患者PTDM总发生率为44.05%,肝移植患者在糖代谢异常早期即存在胰岛素抵抗,胰岛β细胞功能则随糖代谢异常加重而进行性衰退.Objective To evaluate the status of abnormal glucose metabolism in patients being alive over 3years after liver transplantation and discuss the possible mechanism of post-transplant diabetes mellitus （ PTDM ）.Methods In this study, the clinical data of patients with liver transplantation were collected from April 2001 to December 2008. Patients with diabetes mellitus before operation and those who had died and failed to appear during follow-up were exluded. 199 patients living over 3 years after liver transplantation were follow-up. The prevalence of PTDM was evaluated according to fasting plasma glucose（FPG）. Among those without diabetes according to FPG,32patients underwent 75 g oral glucose tolerance test （OGTT） , and fasting and 2 h plasma glucose and insulin were determined. 32 patients were divided into three groups [normal, impaired glucose regulation （ IGR ） , and PTDM groups], proportion of PTDM and homeostasis model assessment （ HOMA ） index were calculated. Results In patients alive over 3 years after liver transplantation, the prevalence of PTDM was 34.67% according to FPG. The OGTT result showed that the proportion of PTDM was 9.38%, IGR, including impaired fasting glucose（IFG） and impaired glucose tolerance （ IGT ） , was 56. 25% , while 34. 37% remained normal. The homeostasis model assessment β cell function index（ HOMA-β ） decreased progressively from normal group, IGR group to PTDM group,and that in PTDM group was significantly lower than those in normal and IGR group（ P〈0.01 ）. IGR group had the highest homeostasis model assessment for insulin resistance （HOMA-IR） and PTDM group the next, and HOMA-IR in IGR group was significantly higher than normal group. Conclusion In patients alive over 3 years after liver transplantation, the prevalence of PTDM reached 44.05%. Insulin resistance existed during early period of impaired glucose regulation, while the degeneration of β cell progressed with the worsening of impaired glucose regulation.

关 键 词：肝移植 移植后糖尿病 发生率 发病机制 

分 类 号：R587.1[医药卫生—内分泌] R657.3[医药卫生—内科学]