肝移植术后1月空腹血糖变化

The change of fasting plasma glucose in the first month of liver transplantation

目的观察肝移植术后1月内血糖变化,以探讨肝移植术后血糖变化规律以及肝移植术后糖尿病的相关危险因素。方法本文收集中山医院2001年3月至2007年2月共514例肝移植患者临床资料,排除资料不完整及术前使用糖皮质激素的患者,共有324例患者进入本组分析,其中男性263例,女性61例,年龄3～81岁,平均48.9岁。根据术前空腹血糖将患者分为糖尿病组（diabetes mellitus,DM）、空腹血糖受损组（impairedfasting glucose,IFG）及空腹血糖正常组（normal fasting glucose,NFG）,根据患者术后使用的免疫抑制剂类型将患者分为FK506组及环孢霉素组。采用重复测量的方差分析观察手术前后糖代谢变化情况。通过分析术前与术后4周（取术前及术后1,3,7,14,21,28 d）各组患者空腹血糖资料,得出各组术前及术后4周内的空腹血糖变化趋势,计算术后高血糖状态患病百分比,并分析术后高血糖状态的术前危险因素与药物影响。结果肝移植术后4周内DM,IFG,NFG 3组空腹血糖均呈先升高后降低的变化趋势,空腹血糖以DM组最高,IFG组次之,NFG组最低,3组之间变化趋势两两比较均有统计学差异（P值均〈0.000 1）;术前非糖尿病组患者术后1月内高血糖状态患病百分比为：术后1 d为100%,之后逐渐降低,至术后28 d为73.6%;术前空腹血糖及年龄对术后7 d空腹血糖有明显影响;FK506组和环孢霉素组之间术后4周内空腹血糖变化无明显差异。结论肝移植术后早期DM,IFG,NFG 3组空腹血糖均较术前有明显升高;术前非糖尿病组患者术后1月内高血糖状态患病百分比由100%逐渐降至73.6%;FK506组和环孢霉素组之间术后1月内空腹血糖变化趋势无明显差异。

Objective To observe the change of blood glucose in the first month of liver transplantation in order to investigate the rule of change of blood glucose after liver transplantation and the correlated risk factors of post-transplant diabetes mellitus. Methods Five hundred and fourteen liver transplantation patients were enrolled from March 2001 to February 2007 in Zhongshan Hospital, among them 324 patients were analyzed, including 263 men and 61 women, aging from 3 to 81 years old （mean age 48.9 years）, with excluding patients with uncomplete data or history of using glucocorticoid. Patients were divided into 3 groups according to the fasting plasma glucose previous to surgery, diabetes mellitus （DM）, impaired fasting glucose （IFG） and normal fasting glucose （NFG）, and into 2 groups according to the different treatment of medicine after transplantation （FKS06 and cyclosporine）. By comparing fasting plasma glucose before and 4 weeks after surgery （ 1,3,7,14,21 and 28 days after surgery）, we surveyed the trend of fasting plasma glucose fluctuation using ANOVA of repeated measurements, and the percentage of hyperglycaemia status during the first 4 weeks after surgery in each group and analyzed the correlated risk factors and drug influence of hyperglycaemia status after surgery. Results The trend of fasting plasma glucose fluctuation during the first 4 weeks was similar in all of the 3 groups, which was elevated in the first day after surgery and then declined. However, fasting plasma glucose levels between any two of the three groups were significantly different （P〈0. 000 1）. Moreover, the fluctuation of fasting plasma glucose was most obvious in DM group, then in IFG group, and the least in NFG group. The percentage of hyperglycaemia status in preoperative nondiabetic group during the first 4 weeks after surgery was： 100% in the first day after surgery, decreasing to 73. 6% in the 28th day after surgery. The preoperative fasting plasma glucose and age were risk factors of hyperglycaemia status at 7th day after surgery. There were no difference of the trend of fasting plasma glucose during the first 4 weeks between FK506 group and cyclosporine group. Conclusions The fasting plasma glucose during the early period after surgery was elevated significantly in each group. The percentage of hyperglycaemia status in preoperative nondiabetic group during the first 4 weeks after surgery was decreased from 100% to 73.6 % gradually. There is no differenee of the trend of fasting plasma glucose during the first 4 weeks between FK506 group and eyclosporine group.