影响肝移植术后新发糖尿病逆转的相关因素

Related factors associated with reversal of new-onset diabetes mellitus following liver transplantation

目的探讨影响肝移植术后新发糖尿病（PTDM）逆转的相关因素。方法回顾分析232例肝移植受者的临床资料，术后共有62例患者发生PTDM，发生率为26．7％。根据PTDM是否发生逆转，将62例患者分为暂时性PTDM组（34例）和持续性PTDM组（28例）。对两组患者的性别、年龄、体重指数、糖尿病家族史、乙型肝炎病毒感染情况、术前空腹血糖水平、免疫抑制剂使用及其血药浓度、皮质激素的使用时间等相关因素进行分析。结果两组间患者的性别、体重指数、糖尿病家族史、术前空腹血糖水平、免疫抑制方案中皮质激素的持续使用时间、术后血他克莫司浓度及使用环孢素A的患者比例等因素的差异均无统计学意义（P〉0．05）。与持续性PTDM组相比，暂时性PTDM组患者移植时年龄较轻，分别为（54±8）岁和（42±6）岁（P〈0．05）；发生PTDM的术后时问较晚，分别为术后（18±23）d和（35±42）d（P〈0．05）；免疫抑制方案中联合运用吗替麦考酚酯（MMF）或西罗莫司（SRL）的患者比例较高，分别为0和8．9％（P〈0．05）。经多因素Logistic回归分析显示，只有移植时年龄是PTDM逆转的独立预测因子（比值比为1．312，95％可信区间为1．005～1．743）。结论患者移植时年龄、发生PTDM时的术后时间及免疫抑制方案中使用MMF或SRL的患者比例等因素与肝移植术后PTDM逆转相关，但只有移植时年龄是PTDM逆转的独立预测因子。

Objective To study the related factors associated with the reversal of posttransplant diabetes mellitus （PTDM） following liver transplantation. Methods The clinical data of 62 patients with PTDM in 232 patients receiving liver transplantation （26. 7 % ） were retrospectively analyzed and the patients were divided into two groups： patients with transient PTDM （34 cases） and those with persistent PTDM （28 cases）. Pre-operative and post-operative variables, including sex, age, body mass index, family history of diabetes, hepatitis B virus infection, pretransplantation fasting plasma glucose, the immunosuppressant regime, FK506 concentration and duration of steroid usage, were analyzed retrospectively. Results The variables, including sex, age, body mass index, family history of diabetes, hepatitis B virus infection, pretransplantation fasting plasma glucose, FK506 concentration at month 1, 3 and 6 after operation, rate of cyclosporine usage and duration of steroid usage had no significant difference between the two groups （P〉0. 05）. Compared with the persistent PTDM patients, the transient PTDM patients were characterized by younger age at the time of transplantation （54 ± 8 vs. 42 ± 6 years, P〈0. 05）, longer time before the development of PTDM （18 ± 23 vs. 35 ± 42 days, P〈0. 05）, and higher rate of mycophenolate mofetil or sirolimus usage （0 vs. 8. 9 %, P〈 0. 05）. Based on a multivariate analysis, age at the time of transplantation was determined as the single independent predictive factor associated with reversal of PTDM following liver transplantation （odds ratio： 1. 312, 95 % confidence interval.. 1. 005 - 1. 743）. Conclusion Age at the time of transplantation, duration before the development of PTDM and rate of mycophenolate mofetil or sirolimus usage are associated with reversal of PTDM following liver transplantation. Among these factors, age at the time of transplantation is only the single independent predictive factor.