心脏移植术后新生糖尿病的危险因素分析

Study on risk factors for new onset diabetes mellitus post orthotopic heart transplant （PTDM） and the relationship between PTDM and long-term survival

目的探讨原位心脏移植术后新生糖尿病的发病率、发生的独立危险因素及其对患者长期存活的影响。方法对术前病史资料详实、无糖尿病、术后存活时间大于6个月的92例原位心脏移植患者进行回顾性研究。患者平均随访31个月。随访期间发生移植后新生糖尿病者（PTDM组）共19例（19／92，20．7％），未发生新生糖尿病者（NPTDM组）73例。记录与移植后新生糖尿病相关的因素，并对可能的危险因素进行单因素分析和多因素回归分析。记录原位心脏移植术后新生糖尿病的发病率。绘制患者的Kaplan-Meier生存曲线。结果移植后患者整体的空腹血糖水平较移植前明显升高[移植后为（5．52±1．07）mmol／L，移植前为（4．95±0．64）mmol／L，P〈0．01]。多因素Logistic回归分析显示，移植后新生糖尿病发生的独立危险预测因素是高龄（OR=1．09，P〈0．05）、体重指数（OR=1．45，P〈0．01）、糖尿病家族史（OR=7．97，P〈0．05）和术前空腹血糖（OR=5．83，P〈0．01）。92例患者术后1、3和5年存活率分别为96．29％、88．80％和80．62％，PTDM组术后1、3和5年存活率分别为87．50％、72．92％和72．92％，NPTDM组术后1、3和5年存活率分别为96．95％、93．44％和81．95％。分层次Log-rank检验显示，PTDM组和NPTDM组的两条生存曲线无明显差异（P〉0．05）。结论移植后新生糖尿病的独立危险因素包括年龄、糖尿病家族史、体重指数和术前空腹血糖状态。

Objective To investigate the incidence and presence of risk factors for new onset diabetes mellitus post orthotopic heart transplant （PTDM）, and the relationship between PTDM and long-term survival after heart transplantation （HT）. Methods Ninety-two non-DM patients were studied, who underwent ortbotopic heart transplantation from September 2000 to December 2006 and had follow-up regularly. According to the diagnostic criteria of PTDM, they were divided into two groups. All variables that could be related to the development of PTDM during follow-up were analyzed, and the risk factors for PTDM were determined. Student t-test, Wilcoxon rank sum test and x^2 test were used for univariate statistical analysis and logistic regression for multivariate analysis. The incidence of PTDM was recorded. Kaplan-Meier method and log rank test were used for survival analysis. Results Of the 92 patients, 19 developed DM （20. 7%）. Student t-test revealed that mean fasting blood glucose level after transplantation was higher than pre-transplant （5.52 ± 1.07 vs 4. 95 ± 0. 64, P〈0. 01 ）. The multivariate analysis identified the following as predictive factors for the development of PTDM： age （OR = 1.09, P〈0. 05）, body mass index （BMI） （OR = 1.45, P〈 0. 01 ）, family history of DM （OR= 7. 97, P〈0. 05）, fasting blood glucose level before operation （OR = 5.83, P〈0.01 ）. Overall patient survival rate at one, three and five-yr post transplant was 96. 29%, 88. 80 %, and 80. 62 % respectively. The survival rate in PTDM patients at one, three and five-yr post transplant was 87. 50 %, 72. 92 %, 72. 92 %, respectively. The survival rate in NPTDM patients at one, three and five-yr post transplant was 96. 95%, 93. 44 %, 81.95%, respectively, which revealed that patients with PTDM had the worse outcome （P〉 0. 05 ）. Conclusion Age,Preoperative overweight especially body mass index, family history of DM, and fasting blood glucose level were significant and independent risk factors for the development of PTDM during follow-up.