恶性血液病患者接受造血干细胞移植后发生糖尿病的危险因素分析

Risk factors for the occurrence of diabetes after hematopoietic stem cell transplantation for treating malignant hematopathy

目的:造血干细胞移植是目前根治血液病的惟一方法。调查分析恶性血液病造血干细胞移植后糖尿病发生及发展的危险因素。方法:①对象和分组:收集2003-01/2007-02武汉市中心医院行造血干细胞移植后患者和外院行造血干细胞移植后转至武汉市中心医院的患者16例。根据干细胞移植术后血糖水平分为糖尿病组6例,非糖尿病组11例,两组平均年龄45.2岁。②评估:分析移植后糖尿病的发生与患者年龄、术前疾病状态(化疗次数、大剂量强化的次数、血压状态、糖耐量情况)、免疫抑制剂、皮质激素用量及时间的关系,以及移植后糖尿病对患者的影响。结果:16例患者均进入结果分析。①术后出现5例糖尿病;术前有糖耐量异常者其移植后糖尿病的发生率高于无糖耐量异常者。②年龄大于40岁、曾经多次使用过含有糖皮质激素化疗方案的患者,其糖尿病的发病率较高;激素半年内撤离的患者移植后糖尿病的发生率明显低于半年内未撤离者。③两组患者使用免疫抑制剂及血药浓度的情况对糖尿病的发生无影响。④糖尿病组对术后巨细胞病毒感染率无明显影响。结论:年龄大于40岁、曾多次使用过含糖质皮激素的化疗方案、糖耐量异常、长期使用糖皮质激素预防移植物抗宿主反应者是糖尿病的高危人群。

AIM： Hematopoietic stem cell transplantation is the only method to cure hematologic disease. This article analyzes risky factors as to suffering and development of diabetes after hematopoietic stem cell transplantation for malignant hemopathy. METHODS： ①Sixteen patients who received hematopoietic stem cell transplantation were enrolled at the Wuhan Central Hospital from January 2003 to February 2007. They were divided into diabetic （n=6） and non-diabetic （n=l 1） groups with an average age of 45.2 years. ②The interrelationship between occurrences of diabetes after hematopoietic stem cell transplantation and patients＇ age, symptom before operations （times of chemotherapy, times of large amount of dosage for intensifying treatment, status of blood pressure, sugar tolerance）, immunosuppressant, dosage and time of cortex incretion as well as effect of diabetes on patients. RESULTS： Sixteen patients were included in the final analysis ①5 cases of diabetes occurred after surgery; patients with abnormal sugar tolerance before surgery possessed a higher rates of occurrence of diabetes than those with normal sugar tolerance; ②Those patients of older than 40 years and who had taken in sugar-containing cortex incretion during chemotherapy also possessed a comparatively higher rates of occurrence of diabetes; Patients whose intake of cortex incretion have being cancelled after half a year of transplantation possessed an obviously lower rates of occurrence of diabetes than those intake of cortex incretion had being cancelled within half a year of transplanting operation. ③ Application of immunosuppressant and plasma drug concentration had no affect on occurrence of diabetes in both groups. ④No evident effect of infection rate of cytomegalovirus was detected in the diabetic group. CONCLUSION： Those patients that are older than 40 years and who have taken in sugar-containing cortex incretion during chemotherapy and with abnormal sugar tolerance as well as taking in sugar-containing cortex incretion to prevent occurrence of graft-versus-host-disease （GVHD） possess relatively higher rates of occurrence of diabetes.