血液病患者异基因外周血造血干细胞移植术后高血糖发生危险因素分析

Risk factor for developing posttransplant hyperglycaemia after allogene peripheral blood stem cell transplantion in hematologic disease patients

目的探讨血液病患者异基因外周血造血干细胞移植术(allo-PBSCT)后高血糖的发生情况及危险因素。方法选择接受allo-PBSCT至今仍无病生存的血液病患者62例,根据术后是否发生高血糖分为高血糖组15例和对照组47例,对患者的临床资料进行回顾性分析。结果①将移植后糖尿病和糖耐量受损(IGT)、空腹血糖受损(IFG)均做为移植后高血糖,结果移植后高血糖15例(24.19%)。②单因素分析显示,移植后高血糖的发生与移植年龄、回访时年龄、移植前体质量、服用环孢菌素A时间、服用糖皮质激素时间及用量、移植前吸烟史及移植后高血压密切相关(P均<0.05)。③Logistic多因素分析表明,糖皮质激素累积使用剂量、环孢素A使用时间、移植后高血压的发生是引起高血糖的独立危险因素(P均<0.05)。结论高血糖是血液病患者allo-PBSCT后常见的并发症,糖皮质激素累积使用剂量、环孢素A使用时间以及移植后高血压的发生是引起移植后高血糖发生的独立危险因素。

Objective To investigate the risk factors for post transplant hyperglycaemia undergoing allogene peripheral blood stem cell transplantion（allo-PBSCT） in hematologic disease patients. Methods 62 patients undergoing allo-PBSCT with hematologic disease were divided into 2 groups： hyperglycaemia group and control group. Variables were analyzed using T-test and chi-square analysis methods. Logistic regression analysis was done to rank the relative risk of potential variables and calculate the 95% confidence interval （CI）. Results Posttransplant hyperglycaemia patients included posttransplant diabetes mellitus（PTDM） ,impaired glucose tolerance（IGT） and impaired fast glucose（IFG） . Posttransplant hyperglycaemia developed in 15 patients（24.19% ）. On univariate analyses, posttransplant hyperglycaemia was close correlated with many factors respectlvly （P ≤0.05 ） , such as ages, weight of pretrausplant, the time of apply ciclosporin A and glucocorti- costeroid,cumulative dosage of glucocorticosteroid, smoking history and hypertension after allo-PBSCT. Multivariate and Logistic regression analysis revealed that the risk factors for hyperglycaemia were identified as, appliy time of ciclosporin A and development of hypertension after ailo-PBSCT. Conclusions Hyperglycaemia is a common allograftic complication in recipients after allo-PBSCT with hematologic disease. The cumulative dosage of steroids, using time of CsA and development of hypertension after allo-PBSCT were independent risk factors for posttransplant hyperglycaemia hyperglycaemia.