肝移植术后新发糖尿病危险因素及对预后影响的研究  

New-onset Diabetes after Liver Transplantation: an Analysis of Risk Factors and Impacts on Outcomes

作　　者：孙亚煌 刘园[1] 藕宝池 樊军卫[1] 彭志海[1] SUN Ya-huang;LIU Yuan;OU Bao-chi;FAN Jun-wei;PENG Zhi-hai(Department of General surgery,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200080,China)

机构地区：[1]上海交通大学附属第一人民医院普外科

出　　处：《现代生物医学进展》2019年第20期3845-3848,3811,共5页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81530044)

摘　　要：目的:研究肝移植术后新发糖尿病的危险因素以及新发糖尿病对肝移植受者生存率的影响。方法:收集2007年7月至2014年9月间143例接受原位肝移植且术前无糖尿病的患者资料,根据术后是否新发糖尿病分为术后新发糖尿病(NODM)组(33例)和无糖尿病(non-NODM)组(110例),采用二元logistic回归分析NODM的危险因素,Kaplan-Meier法进行生存分析,Log-rank法比较两组间生存率的差异。结果:单因素比较两组间有显著差异的因素(P<0.05)包括,术前MELD评分,NODM组14.30±6.70 VS non-NODM组11.15±4.67;Child-Pugh评分/分级,NODM组A级9例(26.3%)、B级13例(38.4%)、C级11例(33.3%)VS non-NODM组A级65例(59.1%)、B级35例(31.8%)、C级10例(9.1%);常规应用糖皮质激素,NODM组16例(48.5%)VS non-NODM组31例(28.2%);肝移植术后第1个月血浆他克莫司谷浓度,NODM组8.68±2.61 VS non-NODM组7.44±2.34;术后第1个月血清AST,NODM组55.72±33.34 VS 44.16±24.17。多因素回归分析结果示,肝移植术前Child-Pugh分级(P=0.001):B级无统计学意义(P>0.05),C级(P<0.001,OR=11.996,95%CI:3.340-43.089)和移植术后第1个月血浆他克莫司谷浓度(P=0.013,OR=1.306, 95%CI:1.058-1.612);NODM组患者生存率显著低于non-NODM组(P=0.001)。结论:肝移植术前Child-Pugh分级C级和移植术后第1个月血浆他克莫司谷浓度是NODM的独立危险因素,NODM显著降低患者生存率。Objective: To study the risk factors of new-onset diabetes after liver transplantation and the impacts of new-onset diabetes on the survival of liver transplant recipients. Methods: A total of 143 patients who underwent orthotopic liver transplantation during July 2007 to September 2014 and had no preoperative diabetes were enrolled. The patients were divided into the new-onset diabetes mellitus(NODM) group(33 cases) and the non-new onset diabetes mellitus(non-NODM) group(110 cases), according to whether developed diabetes postoperative. The risk factors of NODM were analyzed with binary logistic regression model, patient survival was calculated by Kaplan-Meier curve and compared using log-rank test. Results: Differences between the NODM group and non-NODM group in univariate analysis were significant(P <0.05) on preoperative MELD score(14.30 ±6.70 VS 11.15 ± 4.67),Child-Pugh class A(26.3% VS 59.1%), class B(38.4% VS 31.8%), and class C(33.3% VS 9.1%), corticoid therapy(48.5% VS 28.2%),trough blood concentration of tacrolimus(8.68±2.61 μg/L VS 7.44±2.34 μg/L), and serum concentration of AST(55.72±33.34 U/L VS 44.16±24.17 U/L) in first month after transplantation. In multivariate analysis, only Child-Pugh class C(P<0.001, OR=11.996, 95%CI: 3.340-43.089), trough blood concentration of tacrolimus(P=0.013, OR=1.306, 95% CI: 1.058-1.612) were statistical significant.Patient survival in NODM group was significantly lower than that in non-NODM group(P=0.001). Conclusions: Child-Pugh class C before liver transplantation and trough blood concentration of tacrolimus in first month posttransplantation were independent risk factors of NODM after liver transplantation. Meanwhile, NODM reduced patient survival significantly.

关 键 词：肝移植 新发糖尿病 危险因素 预后 

分 类 号：R657.3[医药卫生—外科学] R587.2[医药卫生—临床医学]