体质量指数与接受成人脂肪肝供体的肝移植术后糖尿病关系探讨

Relationship between body mass index and new-onset diabetes after liver transplantation using steatotic grafts

目的探讨体质量指数(BMI)与接受成人脂肪肝供体的肝移植术后新发糖尿病(NODAT)的关系。方法对接受成人脂肪肝供体的肝移植术的181例患者资料进行回顾性分析,其中消瘦组5例(BMI<18.5 kg/m^2),正常组82例(18.5 kg/m^2≤BMI<24 kg/m^2),超重组65例(24 kg/m^2≤BMI<28 kg/m^2),肥胖组29例(BMI≥28 kg/m^2)。又根据患者有无NODAT,分为NODAT组57例和非NODAT组124例。比较各组受体的一般资料、术后并发症的差异。利用二元Logistic回归分析影响脂肪肝供体肝移植NODAT的危险因素,并绘制Kaplan-Meier生存曲线对患者肝移植术后1、3、5年累积生存率进行分析。结果肥胖组术前血清白蛋白低于正常组和超重组(P<0.05);超重组和肥胖组患者NODAT发生率高于正常组(P<0.01),肥胖组患者NODAT发生率高于消瘦组和超重组(P<0.05);二元Logistic回归分析示,超重(OR=3.423,95%CI:1.410~8.310)和肥胖(OR=16.808,95%CI:6.023~46.907)是脂肪肝供体肝移植NODAT发生的独立危险因素;生存曲线显示,肥胖组5年累积生存率明显低于其他3组(Log-rankχ^2=44.998,P<0.01)。结论超重和肥胖是成人脂肪肝供体肝移植NODAT发生的危险因素,术前合理控制患者BMI可显著改善移植预后。

Objective To explore the correlation between different body mass index(BMI)and new-onset diabetes(NODAT)after steatotic liver transplantation in adults.Methods The clinical data of 181 patients who underwent steatotic liver transplantation were retrospectively analyzed.Patients were divided into four groups including 5 patients in the thin group(BMI<18.5 kg/m^2),82 patients in the normal group(18.5 kg/m^2≤BMI<24 kg/m^2),65 patients in the overweight group(24 kg/m^2≤BMI<28 kg/m^2)and 29 patients in the obese group(BMI≥28 kg/m^2).Clinical data,incidence of complications and accumulated survival rates were compared between 4 groups.Binary Logistic regression were used to assess the risk factors of diabetes after steatotic liver transplantation,and the Kaplan-Meier survival curves were drawn to analyze the 1-year,3-year and 5-year cumulative survival rates of patients.Results The serum albumin level was significantly lower in the obese group than that of the normal group and overweight group(P<0.05).Compared with the normal group,the incidence of NODAT was significantly increased in the overweight group and obese group(P<0.01).The incidence of NODAT was significantly higher in the obese group than that of the overweight group(P<0.01).The incidence of NODAT was significantly higher in the obese group than that of the thin group(P<0.05).Logistic analysis showed that the over weight(OR=3.423,95%CI:1.410-8.310)and obesity(OR=16.808,95%CI:6.023-46.907)were independent risk factors in the development of NODAT in steatotic liver transplantation(OR=1.363,95%CI:1.214-1.530).Survival curves revealed that the survival rate of the obese group was observably lower than that of the other 3 groups(Log-rankχ^2=44.998,P<0.01).Conclusion Overweight and obesity are independent risk factor for the occurrence of NODAT after steatotic liver transplantation,and rational control of BMI before surgery can significantly improve the prognosis.