儿童肾移植术后随访期新发糖尿病五例诊治

A report of 5 cases of post-transplantation diabetes mellitus after kidney transplantation in children

目的总结分析儿童肾移植术后新发糖尿病(PTDM)的临床特点及治疗经验。方法2014年5月至2021年3月华中科技大学同济医学院附属同济医院门诊规律随访的93例儿童肾移植受者中(中位随访时间34个月),5例(5.38%)被诊断为PTDM。回顾性分析5例儿童受者的临床资料,总结发病特点、治疗方案及转归。5例儿童PTDM中男性1例,女性4例,年龄在12~17岁。5例患儿均使用他克莫司为基础的免疫抑制方案,口服糖皮质激素均在移植后0.5~3.0个月停用。结果PTDM的中位发病时间在肾移植术后17个月(1~46个月)。诊断为PTDM后,2例儿童受者将他克莫司转换为环孢素A,其中1例儿童受者需临时辅助胰岛素治疗,之后2例儿童受者血糖均逐渐恢复正常。3例未转换环孢素A的儿童受者均需依赖降糖药物,1例单服阿卡波糖,1例单服二甲双胍,1例需二甲双胍联合阿卡波糖。中位随访6个月(2~10个月),5例儿童受者血糖控制稳定,血肌酐及尿蛋白较前无显著变化。结论儿童PTDM的治疗应综合考虑年龄、性别和患儿的诉求制定个体化方案,他克莫司转换为环孢素A可能会逆转糖尿病,不转换时需联合二甲双胍等药物控制血糖。

Objective To summarize the clinical characteristics and therapeutic drug selection of post-transplantation diabetes mellitus(PTDM)after kidney transplantation in children.Methods From May 2014 to March 2021,a total of 5 cases(5.38%)of 93 paediatric kidney transplant recipients with a median follow-up period of 34 months were diagnosed with PTDM in our centre.Retrospective data analysis was performed for these 5 paediatric recipients.The characteristics of the disease,treatment data and outcomes were summarized.Among the five paediatric recipients,one was male and four patients were female,ranging the age from 12 to 17 years.All recipients received a tacrolimus-based immunosuppressive regimen with prednisone discontinued no later than 3 months after kidney transplant.Results The onset of PTDM ranged from 1 month to 46 months(median:17 months)after transplantation.The blood glucose of two children returned to normal gradually after tacrolimus conversion to cyclosporine,with one of them was given insulin temporarily.Three children received oral hypoglycaemic agents,including one received acarbose,one received metformin,and one received metformin combined with acarbose.After a median follow-up of 6 months,the levels of blood glucose in five children were stable,and there was no significant change in serum creatinine and urine protein.Conclusions The treatment of PTDM in children should be individualized with considering of age,gender and immunosuppressive regimen.Switch from tacrolimus to cyclosporine is effective.Metformin or other hypoglycemic agentsis helpful when tacrolimus is maintained.