肾移植受者发生移植后糖尿病的危险因素分析

Risk factors of post-transplant diabetes mellitus in kidney transplant recipients

目的分析肾移植受者发生移植后糖尿病(PTDM)的危险因素,并评价其预测价值。方法回顾性分析531例肾移植受者的临床资料。根据是否发生PTDM,分为PTDM组(247例)和非PTDM组(284例)。收集我院2016—2020年接受肾移植患者相关临床信息,采用t检验或χ^(2)检验,分析2组间PTDM风险因素差异水平;采用单因素Logistic回归分析,将单因素Logistic回归分析有统计学意义的因素纳入到多因素分析;最后采用受试者工作曲线(ROC)评价风险指标的预测效能。结果糖尿病家族史、体质量指数(BMI)、钙调磷酸酶抑制剂(CNI)类型、术前餐后2 h血糖是肾移植受者发生PTDM的独立危险因素。ROC曲线结果表明,联合糖尿病家族史、BMI、CNI类型、术前餐后2 h血糖危险因素,预测肾移植术后发生PTDM的曲线下面积(AUC)95%CI为[0.919(0.859~0.980)],敏感度、特异度分别为0.850、0.833,截断值为0.683(P<0.05)。结论糖尿病家族史、BMI、CNI类型、术前餐后2 h血糖是经过肾移植手术患者发生PTDM的独立危险因素;联合糖尿病家族史、BMI、CNI类型、术前餐后2 h血糖等指标可以提高PTDM的预测效能。

Objective To investigate the risk factors of post-transplant diabetes mellitus(PTDM)in kid-ney transplant recipients and evaluate their predictive value in PTDM.Methods Clinical data of patients under-going kidney transplantation in our hospital between 2016 and 2020 were collected retrospectively.There were 531 kidney transplant recipients included in this study.According to occurrence of PTDM,the subjects were di-vided into the PTDM group(n=247)and non-PTDM group(n=284).T-test or chi-square test was used to analyze the differences in risk factors for PTDM between the two groups.Univariate logistic regression analysis was used examine these factors.The factors with statistical significance in univariate logistic regression were further includ-ed in the multivariate analysis.Finally,receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the risk factors.Results Family history of diabetes,body mass index(BMI),calcineurin inhi-bitor(CNI)type,and 2h postprandial blood glucose before transplantation were independent risk factors for PTDM in kidney transplant recipients.ROC curve showed that a combination of risk factors including family history of diabetes,BMI,CNI type,and 2h postprandial blood glucose before transplantation,yield an area under the curve(AUC)of 0.919[95%CI(0.859,0.980)]in predicting PTDM after kidney transplantation,with a sensitivity of 0.850,a specificity of 0.833,and a cut-off value of 0.683(P<0.05).Conclusion Family history of diabetes,BMI,CNI type,and 2h postprandial blood glucose before transplantation are independent risk factors for PTDM in patients undergoing kidney transplantation.Combination of these risk factors can lead to better predictive performance of PTDM.