肾移植术后糖尿病的临床特性及高危因素

Clinical characteristics and high risk factors of diabetes mellitus following renal transplantation

目的研究肾移植术后糖尿病（ＰＴＤＭ）的临床特性及高危因素。方法将５１２例肾移植患者分为２组，其中４８例ＰＴＤＭ患者为糖尿病组，其余４６４例患者为非糖尿病组。定期监测患者体重、用药情况、生化指标、病毒抗体，并用血清学方法及聚合酶链反应（ＰＣＲ）方法检测主要组织相容性抗原（ＨＬＡ）。结果糖尿病组的平均年龄及术后６个月内激素的用量明显高于非糖尿病组。肾移植术后半年内易出现ＰＴＤＭ，且全部ＰＴＤＭ患者为非肥胖型。大部分ＰＴＤＭ出现时血糖值较高，但不易出现酮症酸中毒。ＰＴＤＭ患者ＨＬＡＢ１５的出现率及腺病毒３型ＩｇＭ抗体的阳性率明显升高。结论遗传因素如某些ＨＬＡ抗原及环境因素如激素和环孢素Ａ的用量、肾移植手术的应激反应。

Objective To investigate the clinical characteristics and risk factors for postrenal transplant diabetes mellitus (PTDM).Methods 512 consecutive kidney recipients were included in this study from 1994.1 to 1997.5. Biochemical data, body weight changes, drug history, genetic markers such as HLA phenotypes, anti virus antibodies were studied in these patients.Results The mean age and the dose of hormone used 6 months after operation in the diabetes mellitus group were older and higher than in the nondiabetes groups respectively. PTDM often occurred half a year following renal transplantation. And no patients with PTDM were obese. Most PTDM patients had a higher blood glucose level, but few of them had ketoacidosis. The occurrence of HLA B15 and the positive rate of anti gland virus antibody were signi ficantly higher in PTDM group.Conclusion Both genetic factors such as HLA type antigens and environmental factors such as the amounts of steroid and cyclosporine A used, infections of some kinds of viruses, and also stress during transplantation may play an important role in the causes of PTDM.