肾移植术后糖尿病的发病及其危险因素分析  

An analysis on the prevalence and risk factors of post-transplant diabetes mellitus after renal transplantation

作　　者：陈敏灵[1] 张尧[1] 于明香[1] 许明[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泌尿外科,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》2013年第9期750-755,共6页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨肾移植术后存活1年以上患者中根据空腹血糖（FPG）异常诊断的移植后糖尿病（PTDM）的发病及其相关危险因素。方法对1993年1月至2008年12月接受肾移植手术的428例术前非糖尿病患者进行随访，根据FPG分析术后PTDM发生率及其相关危险因素。结果428例术前非糖尿病患者，平均随访（5．65±3．68）年，共有87例（20．3％）发生PTDM，其中57例（占总PTDM的65．5％）发生。于术后1年内。单因素分析提示年龄、体重指数（BMI）、吸烟史、糖尿病家族史、尸体供肾、乙型肝炎病毒（HCV）感染、巨细胞病毒感染、术前和术后1周FPG、术前高脂血症、术后环孢素A转换为他克莫司（FK506）、术后6个月和1年环孢素A峰浓度与PTDM明显相关（P〈0．05）。由环孢素A转换为FK506的患者PTDM患病率升高，而由环孢素A转换为雷帕霉素的患者PTDM患病率无明显变化。多因素分析提示术前FPG、年龄、BMI、HCV感染、尸体供肾是PTDM的独立危险因素（P〈0．05或P〈0．01）。结论肾移植患者中有较高的PTDM发生率，应早期预防、早期诊断、早期治疗。Objective To explore the incidence of post-transplant diabetes mellitus （PTDM） by means of fasting plaslna glucose （FPG） and other associated risk factors in patients surviving for more than 1 year after renal transplantation. Methods A total of 428 non-diabetic patients, who underwent kidney transplantation from 1 January, 1993 to 31 Decelnber, 2008, were followed up in order to ascertain the prevalence of PTDM after transplantation and other associated risk factors by means of FPG. Results Of the 428 patients, 87 developed PTDM （ 20.3 % ） within a mean follow-up of （ 5.65 -＋ 3.68 ） years after renal transplantation. The onset of PTDM occun＇ed in 57 patients （65.5% of total PTDM） primarily within the first year after transplantation. Univariate analysis showed that ohler age, body mass index （ BM1 ） , smoking history, family history of diabetes mellitus, deceased donor transplantation, hepatitis C virus infection, cytomegalovims infection, FPG before transplantation as well as 1 week after transplantation, total cholesterol and triglyceride before transplantation, switching from eyclosporine to tacrolimus（FK506） , and peak plasma concentration of cyclosporine in the first 6 and 12 months were associated with the onset of PTDM. The prevalence of PTDM was markedly elevated in the group who has cyclosporine converted to FK506 （P〈0.05） , but not in the group with cyclosporine converted to rapamycin. By multivariate analysis, FPG befi,re transplantation, age, BMI, and deceased donor transplantation were independently associated with the onset of VFDM. Conclusions There is high incidence of PTDM in patients following renal transplantation; and early diagnosis, treatment as well as prevention are mandatory.

关 键 词：肾移植 移植后糖尿病 空腹血糖 危险因素 

分 类 号：R699.2[医药卫生—泌尿科学] R587.1[医药卫生—外科学]