肾移植受者移植前风险因素与移植后糖尿病的相关性分析  

Association of pre-transplant risk factors with post-transplantation diabetes mellitus in kidney transplant recipients

作　　者：陈荣鑫[1] 方佳丽[1] 张磊[1] 李光辉[1] 赖兴强[1] 尹威[1] 徐海林 刘路浩[1] 马俊杰[1] 陈正[1] Chen Rongxin;Fang Jiali;Zhang Lei;Li Guanghui;Lai Xingqiang;Yin Wei;Xu Hailin;Liu Luhao;Ma Junjie;Chen Zheng(Department ofTransplantation,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 511447,China)

机构地区：[1]广州医科大学附属第二医院移植科,511447

出　　处：《中华器官移植杂志》2021年第12期712-716,共5页Chinese Journal of Organ Transplantation

基　　金：广州市临床重大技术项目(2019ZD12)。

摘　　要：目的分析肾移植受者移植前风险因素与肾移植术后糖尿病的关联及预防其发生的意义。方法回顾性分析2018年8月至2020年5月在广州医科大学附属第二医院移植科的290例肾移植受者的术前资料,以术后发生糖尿病为主要结局。使用多变量Logistic回归模型构建A(没有调整协变量)、B(协变量包括:性别、有否透析、供肾类型)、C(协变量包括:性别、有否透析、供肾类型、钙调磷酸酶抑制剂、抗增殖类药物、原发病、空腹血糖、餐后1 h血糖、空腹C肽、餐后1 h和2 hC肽、空腹C肽指数、餐后1 h C肽指数、白蛋白、甘油三酯、总胆固醇)三个模型评估年龄、体重指数、餐后2小时血糖(2 h PG)、糖化血红蛋白(HbA1c)、餐后2 h C肽指数(2h-CPI)与术后发生糖尿病的关系。结果在模型A中,年龄[比值比(OR)1.1,95%置信区间(CI)1.0~1.1]、体重指数(OR 1.2,95%CI 1.0~1.3)、2 h PG(OR1.2,95%CI 1.1~1.4)、HbA1c(OR 2.7,95%CI 1.5~4.9),2 h-CPI(OR 0.7,95%CI 0.5~1.0),模型B、C与A结果相似。年龄、体重指数、2 h PG、HbA1c是术后发生糖尿病的危险因素;2 h-CPI是保护因素。四分位数分层纳入模型,趋势检验差异具有统计学意义(P<0.05)。结论年龄、体重指数、2 h PG、HbA1c、2 h-CPI与肾移植术后糖尿病相关。Objective To analyze the association of pre-transplant risk factors with diabetes mellitus after renal transplantation and examine the significance of preventing the occurrence in kidney transplantation recipients.Methods A total of 290 kidney transplantation recipients were retrospectively reviewed at our transplantation center from August 2018 to May 2020.Diabetes mellitus after renal transplantation was employed as a primary outcome index.Multivariate Logistic regression model was utilized for constructing A(without adjusting for covariates)、B(covariates include:gender,dialysis mode,type of donation)and C(covariates include:gender,dialysis mode,type of donation,calcineurin inhibitor,antiproliferative drugs,primary disease,fasting blood glucose,1 h postprandial blood glucose,fasting C peptide,1 h and 2 h postprandial C peptide,fasting C-peptide index,1 h postprandial C-peptide index,albumin,triglycerides,total cholesterol)to evaluate the relationship between diabetes mellitus after transplantation and age,body mass index,2 h postprandial blood glucose(2 h-PG),HbA1c,and 2 h postprandial C-peptide index(2 h-CPI).Results In model A,age[odds ratio(OR)1.1,95%confidence interval(CI)1.0~1.1],BMI(OR 1.2,95%CI 1.0~1.3),2 h PG(OR 1.2,95%CI 1.1~1.4),HbA1c(OR 2.7,95%CI 1.5~4.9),2 h-CPI(OR 0.7,95%CI 0.5~1.0),model B/C had similar results with A.Age,BMI,2 h PG and HbA1c were all risk factors for diabetes mellitus after transplantation while 2 h-CPI was a protective factor.Quartile stratification was analyzed by regression model.And trend test was significant(P<0.05).Conclusions Age,BMI,2 h PG,HbA1c and 2 h-CPI are correlated with diabetes mellitus after kidney transplantation.

关 键 词：肾移植 肾移植术后糖尿病 风险因素 

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