血糖变异系数对肾移植预后的预测价值

The predictive value of blood glucose variation coefficient for the prognosis of kidney transplantation

目的探讨肾移植术后血糖变异系数能否作为肾移植受者不发生严重不良预后的预测指标。方法选择2017年1月到2018年12月西安交通大学第一附属医院行肾移植手术患者565例,根据随访1年有无严重不良预后分为两组。再收集术后连续14 d空腹血糖结果,比较肾移植术后严重不良预后组和无严重不良预后组是否存在差异。并通过空腹血糖值计算血糖变异系数,根据血糖变异系数受试者工作特征曲线(ROC)计算出截断值、灵敏度、特异度和阳性预测值,评价血糖变异系数对严重不良预后的预测价值。结果和无严重不良预后组相比,严重不良预后组空腹血糖整体水平偏低。严重不良预后组和无严重不良预后组比较,血糖变异系数低,ROC曲线下面积(AUC)为0.88,95%CI:0.837~0.918。当截断值为0.26,灵敏度为63%,特异度为100%。结论肾移植术后血糖变异系数可以作为严重不良预后的预测指标。

Objective To explore whether the coefficient of variation of blood glucose after kidney transplantation can be used as a predictive index for kidney transplant recipients without serious adverse prognosis.Methods A total of 565 patients undergoing kidney transplantation in our hospital from January 2017 to December 2018 were selected.They were divided into two groups according to whether they had a serious adverse prognosis during the one year follow up period.The results of fasting blood glucose for 14 consecutive days after the operation were collected to compare whether there was a difference between the severely poor prognosis group and the non-seriously poor prognosis group after kidney transplantation.The coefficient of variation of blood glucose was calculated by fasting blood glucose value,and the cutoff value,sensitivity,specificity and positive predictive value were calculated according to the coefficient of variation of blood glucose curve(ROC curve)to evaluate the predictive value of coefficient of variation of blood glucose for severely adverse prognosis.Results Compared with that of the group without serious adverse prognosis,the overall level of fasting blood glucose was lower in the severely adverse prognosis group after kidney transplantation.Compared with the group with non-seriously poor prognosis,the blood glucose coefficient of variation of the group with severely poor prognosis were lower.The blood glucose coefficient of variation curve(ROC)calculation showed that the area under the curve(AUC)was 0.88,and the 95%confidence interval(CI)was 0.837 to 0.918.When the cutoff value was 0.26,the sensitivity was 63%,and the specificity was 100%.Conclusion The coefficient of variation of blood glucose after kidney transplantation could be used as a predictive index for predicting the occurrence of serious adverse prognosis.