成人肝移植术后糖尿病逆转相关因素的Meta分析  

Predictive factors associated with reversibility of post-transplantation diabetes mellitus for adult： aMeta-analysis

作　　者：鲁华鹏 肖奇贵 李莹 刘培培 郑鑫[1] 李津 

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061 [2]西安交通大学医学部护理系

出　　处：《中华肝胆外科杂志》2017年第12期799-804,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金（81572733）

摘　　要：目的探讨肝移植术后糖尿病（1YFDM）逆转相关因素，为临床防治移植术后糖尿病提供理论基础。方法检索PubMed、WebofScience、CochraneLibrary（2017年5期）、CNKI、VIP、万方等数据库，收集2016年5月前肝移植术后糖尿病逆转相关因素的观察性研究，利用RevMan5．3软件进行Meta分析。结果本Meta分析共纳入7篇研究、979例患者。分析显示男性持续性PTDM（p-PTDM）发生率高于女性（OR=1．73，95％C／1．19～2．50，P〈0．05）；p-PTDM组年龄大于暂时性PTDM（t-PTDM）组（MD=1．73，95％C／0．07～10．39，P=0．05）；p-PTDM组移植前空腹血糖（FPG）高于t-PTDM组（MD=5．66，95％C／0．11～11．31，P=0．05）；HCV（＋）组p-PTDM发生率高于HVC（-）组（OR=1．52，95％a1．08～2．14，P〈0．05）；麦考酚吗乙酯（MMF）联合应用组P—PTDM发生率高于不使用或低频率使用MMF组（OR=0．26，95％C／0．11～0．61，P〈0．05）；p-PTDM组术后发病时间早于t-PTDM组（MD=～19．08，95％C／-37．08～-1．07，P〈0．05）。术后糖尿病的发生与术前BMI、家族糖尿病史、急性排斥反应无关。结论肝移植术后糖尿病逆转相关因素有性别、年龄、移植前空腹血糖、HCV、MMF使以及术后发病时间，与术前BMI、家族糖尿病史、急性排斥反应无关。Objective To systematically review the predictive factors associated with reversibility of post-transplantation diabetes mellitus in adults using Meta-analysis, and to provide a theoretical basis for clinical prevention and treatment of diabetes after transplantation. Methods Pub Med, Web of Science, Cochrane Library （Issue 5, 2017 ） , CNKI, VIP and WanFang Data were searched from inception until May 2017. Two authors independently assessed the trials for inclusion and extracted the data. Discrepancies were resolved in consultation with a third reviewer. Publication biases were evaluated, and the Meta-analyses were conducted with RevMan5.3. Results A total of 7 studies were analyzed which involved 979 adults. Meta- analysis showed the following significant predictive factors： male （ OR = 1.73, 95% C1 1.19 to 2. 50, P 〈 0. 05） , advanced age （MD = 1.73, 95% Cl O. 07 to 10.39, P = 0.05）, high FPG before transplantation （MD =5.66, 95%CI0.11 to 11.31, P=O. 05）, hepatitis C virus （HCV） infection （OR =1.52, 95%CI 1.08 to 2.14, P 〈 0.05 ）, high frequency of combination therapy with MMF （ OR = 0.26, 95% CI 0.11 to O. 61, P 〈 O. 05 ）, and short time before development of PTDM （ MD = - 19. 08, 95% CI - 37.08 to - 1.07, P 〈 0. 05）. There was no correlation with preoperative BMI, family history of diabetes and acute rejection. Conclusion The study showed that male, advanced age, high FPG before transplantation, hepa- titis C virus infection, high frequency combination therapy with MMF, short time before development of post- transplantation diabetes mellitus were the predictive factors associated with reversibility of post- transplanta- tion diabetes mellitus.

关 键 词：肝移植 移植术后糖尿病 可逆性 META分析 

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