影响肾移植术后糖尿病发病的危险因素及其预防

Risk factors for development of post-renal-transplant diabetes mellitus and its precaution

目的探讨引起肾移植术后糖尿病(PTDM)发病的危险因素及预防。方法将2002年1月至2006年7月在我院行肾移植术的237例患者依是否出现PTDM分为PTDM组(22例)及对照组(215例),对各项参数分别用t检验和x^2检验进行单因素分析后行logistic多因素回归分析,计算其相对危险度(RR)及95%CI。结果 PTDM的发病率为9.3%;术后第1年累积发病率为5.1%;单因素及logistic多因素回归分析表明:年龄>40岁、急性排斥的频率及激素的累积使用剂量是发生PTDM的危险因素(P均<0.01)。结论 PTDM是肾移植术后常见并发症,多发生于移植术后1年之内;年龄>40岁,发生急性排斥及糖皮质激素累积使用量较大者发生PTDM的风险增大,应加强监测,及时治疗。

Objective To investigate the risk factors for development of post-renal-transplant diabetes mellitus （PTDM） and its precaution. Methods Clinical data of 237 patients undergoing renal transplant from Jan 2002 to July 2006 were retrospectively analyzed. All patients were divided into 2 groups： PTDM group （22 cases） and control group （215 cases）. 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% CI. Results 22 （9.3%） PTDM patients were diagnosed. Cumulative incidence of PTDM at the first year postransplant were 5.1%. Univariate and logistic regression analysis revealed that the risk factors（RR, 95 % CI） for PTDM were age over 40 years （1.08 ; 1.02～ 1.14 ; P = 0. 007）, acute rejection episodes（26. 9 ; 5.61 ～ 129.8 ; P〈 0. 001） and cumulative dosage of steroids （1.54 ; 1.21～1.96; P〈0. 001）. Conclusions PTDM is a common allograft complication in the renal transplant recipients and has its onset mostly within the first year after transplant. PTDM must be emphatically monitored and treated in time during this period. Age over 40 years, rejection and subsequent increase of cumulative dosage of steroids are independent risk factors for the development of PTDM.