肾移植术后空腹血糖变化规律及其对预后的影响分析

Analysis on the changing trend of fasting plasma glucose and its impact on prognosis after renal transplantation

目的 探讨肾移植术后存活1年以上患者空腹血糖变化规律及其对预后的影响。方法收集446例1993年1月至2008年12月接受肾移植手术且移植肾存活1年以上患者的临床资料，根据术前空腹血糖，将患者分为移植前糖尿病、空腹血糖受损、空腹血糖正常3组，观察各组术后空腹血糖变化规律。对428例术前非糖尿病患者，根据空腹血糖分析术后移植后糖尿病（PTDM）发生及转归，比较持续性PTDM和-过性PTDM临床特点，并比较PTDM组和非PTDM组术后并发症及生存率的差异。结果肾移植后患者血糖整体呈先升高后下降的趋势。428例术前非糖尿病患者，共有87例（20．3％）发生PTDM，其中15例（占总PTDM的17．2％）在随访中转为空腹血糖正常或空腹血糖受损。与持续性PTDM相比，一过性PTDM患者急性排斥反应发生率更高（P=0．043）。与非PTDM组相比，PTDM组术后感染、高血压和脂代谢紊乱发生率更高（P〈0．05）。平均随访（5．65±3．68）年，两组患者生存率和生存时间未见明显差异。结论PTDM并非持续存在，在病程中有可能转为空腹血糖受损或空腹血糖正常。急性排斥反应是一过性血糖升高的危险因素。肾移植后PTDM患者术后更容易发生感染、高血压、高血脂等并发症，但本组术后随访，存活率未受明显影响。

Objective To explore the long-term fluctuation of fasting plasma glucose （FPG） and its effect on prognosis in patients surviving for more than 1 year after renal transplantation. Methods Four hundred and forty-six patients underwent kidney transplantation from January, 1993 to December, 2008. According to preoperative FPG levels, patients were divided into diabetic, impaired fasting glucose （ IFG ） , and normal fasting glucose （ NFG ） groups. The changing trend of FPG level was observed and analyzed. For 428 non-diabetic patients before transplantation, the prevalence and different outcomes of post-transplantation diabetes （PTDM） according to FPG after transplantation were analyzed. The characteristics of the patients with persistent PTDM （ P-PTDM ） and transient PTDM （ T-PTDM ） were compared. The incidence of complications and patient survival between the PTDM group and non-PTDM groups were also compared. Results FPG level was increased early and then decreased in patients after renal transplantation. Of the 428 patients, 87 developed into PTDM （ 20. 3% ） including 15 T-IYFDM patients （ 17. 2% of total PTDM） , who eventually recovered to NFG or IFG. Compared with P-PTDM group, the incidence of acute rejection episodes was higher for T-PTDM （ P = 0. 043 ）. The incidence of infections, hypertension, and dyslipidemia within the first year, was higher in PTDM group compared with non-PTDM group but patient survival was not different within a mean follow-up of （ 5.65 ＋ 3.68 ） years. Conclusion PTDM will not be permanent and may recover to NFG or IFG in the course of the disease. Acute rejections are associated with the onset of T-PTDM. The overall patient survival is not affected by PTDM, although complications, such as infections, hypertention, and hyperlipidemia are more frequently encountered in PTDM patients.