心脏移植术后代谢综合征的发生率及危险因素分析

Metabolic syndrome in heart transplant recipients： prevalence and risk factors （a retrospective study）

目的探讨心脏移植后代谢综合征（MS）的发生率，并分析发生MS的危险因素。方法回顾分析135例心脏移植受者的临床资料。以2004年中华医学会糖尿病学会标准为基础，参照2005年国际糖尿病联盟及修订后的美国国家胆固醇教育计划成人治疗方案第3次报告制定MS的诊断标准。收集可能与发生MS相关的资料进行研究，从而描述心脏移植后MS发生率，对发生MS的危险因素进行单因素和多因素回归分析。结果所有受者的平均随访时间为47．3个月。随访期间，共有63例受者发生MS，其发生率为46．67％（63／135）。受者术前高龄状态（相关系数=1．09，95％可信区间为1．01～1．22，P％0．05），BMI（相关系数=1．65，95％可信区间为1．16～1．87，P〈0．05），以及糖尿病史（相关系数=3．27，95％可信区间为1．12-34．21，P〈0．05）是术后发生MS的独立危险因素。结论心脏移植后MS的发生率较高，术前高龄、肥胖及糖尿病史是导致术后发生MS的独立危险因素，对于高危受者术后应控制好免疫抑制剂用量及饮食。

Objective To determine, in our experience, the prevalence and presence of risk factors for metabolic syndrome （MS） in heart transplant recipients. Methods We studied 135 patients who underwent heart transplantation in our hospital from September 2000 to December 2011, According to the diagnostic criteria of MS, they were divided into two groups. All variables that could be related to the development of MS during the follow-up period were analyzed. The prevalence and presence of risk factors for MS in our experience were determined. Student t-test, Wilcoxon rank sum test and x2 test were used for univariate statistical analysis and logistic regression for multivariate analysis. Results （1） Of the 135 patients, 63 developed MS （46. 67%） during a mean follow-up period of 47.3 months. The multivariate analysis identified the follows as predictive factors for the development of MS： age （OR= 1.09, 95% CI 1.01-1.22, P〈0. 05）, body mass index （BMI） （OR= 1.65, 95% CI 1.16-1.87, P〈0. 05）, history of DM （OR = 3.27, 95% CI 1.12-34. 21, P〈0. 05）. Conclusion In our population, the prevalence of MS after heart transplant is 46. 67% during a mean follow-up period of 47. 3 months. Age, pre-operative overweight especially BMI, and history of DM were significant and independent risk factors for the development of MS during the follow-up period. For these patients, dose of immunosuppressant and diet control are important.