肝移植术后稳定期4种抗排斥方案对血糖的影响

The effect of 4 anti-rejection programs on blood glucose in stable period after liver transplantation

目的回顾性研究分析肝移植术后稳定期4种抗排斥方案应用中出现的血糖异常反应,并对其病因及处理措施进行讨论。方法对肝移植术后稳定期4种抗排斥方案[他克莫司(FK506)联合吗替麦考酚酸酯(MMF)、FK506联合西罗莫司(SRL)、环孢菌素A(CsA)联合MMF、CsA联合SRL]应用中出现的血糖异常反应进行回顾性研究分析,观察空腹血糖受损(im-paired fasting glucose,IFG)、葡萄糖耐量异常(impaired glucose tolerance,IGT)及移植后糖尿病(post transplantation diabetes mellitus,PTDM)的发生率及其对血糖值的影响情况,对其病因及处理措施进行总结和比较。结果 FK506联合MMF组(A组)、FK506联合SRL组(B组)平均血糖水平均高于CsA联合MMF组(C组)和CsA联合SRL(D组),差异均有统计学意义(P<0.01);而A、B组间,C、D组间,平均血糖水平比较差异无统计学意义(P>0.05);IFGI、GT、PTDM发生率在各组间进行两两比较差异均无统计学意义(P>0.05)。结论 FK506相对于CsA对肝移植受者术后的血糖有较大影响,应用以CsA为基础的抗排斥方案,可以降低对患者糖代谢的影响;MMF、SRL对肝移植受者术后的血糖影响相似。

Objective To study and analyze the pathoglycemia responses of 4 anti-rejection programs in stable period after liver transplantation,and to discuss its etiology and treatment.Methods The pathoglycemia responses of 4 anti-rejection programs FK506 unite with MMF,FK506 unite with SRL,CsA unite with MMF,CsA unite with SRL in stable period after liver transplantation were studied and analyzed retrospectively,and the occurrence of impaired fasting glucose（IFG）,impaired glucose tolerance（IGT）,post transplantation diabetes mellitus（PTDM） and the blood glucose level were observed,and its causes and treatment measures were summarized and compared.Results The levels of group-average blood glucose of FK506 unite with MMF group（A group）,FK506 unite with SRL group（B group） were higher than CsA unite with MMF group（C group） and CsA unite with SRL group（D group）,and the differences were statistically significant（P0.01）.B between A and B group,or C and D group,the differences were no statistically significant（P0.05）.Incidence of IFG,IGT and PTDM had no significant difference with multiple comparison in all 4 groups（P0.05）.Conclusion FK506 has greater effects compared with CsA on blood glucose of acceptor after liver transplantation,CsA-based anti-rejection programs can reduce the impact to glucose metabolism.MMF and SRL have the similar effects on blood glucose of acceptor after liver transplantation.