肝移植术后早期发生胰岛素抵抗的危险因素

Risk factors for early insulin resistance after liver transplantation

目的胰岛素抵抗(insulin resistent,IR)是肝移植术后常见的并发症,对于胰岛素抵抗的相关危险因素进行研究有助于改善受体预后。方法回顾性分析2016年1月至2021年6月在新疆医科大学第一附属医院行异体肝移植术后规律随访46例受体临床资料,根据血糖浓度将受体分为正常对照组(n=15)和IR组(n=31),运用单因素和多元Logistic回归分析术后IR的危险因素,并构建Kaplan-Meier生存曲线对比两组间生存时间的差异。结果纳入的46例受体中,IR的发生率为67.39%(31/46),单因素分析中高龄、热缺血时间长、术前FBG、BMI、IL-6较高是术后IR的危险因素,其中热缺血时间是独立危险因素(OR 3.175,95%CI 0.641~1.670,P=0.025),术后CRP、IL-6、TAC血药浓度、FBG水平较高,受体发生IR的风险较高。IR不影响受体的生存率(Log-rank检验:P=0.182)。结论受体高龄、BMI、IL-6、FBG、热缺血时间、CRP、TAC血药浓度与术后IR有关,IR对受体术后生存率无影响。

Objective Insulin resistance(IR)is a common complication after liver transplantation,conducting research to risk factors of insulin resistance will be helpful to improve recipient’s outcomes.Methods The clinical data of 46 recipients who underwent regular follow-up after allogeneic liver transplantation in the First Affiliated Hospital of Xinjiang Medical University from Jan.2016 to Jun.2021 were retrospectively analyzed.According to the diagnostic criteria,the 46 recipients were divided into Normal group(n=15)and IR group(n=31).Logistic regression analysis was performed to analyze the risk factors of postoperative IR,and Kaplan-Meier survival curves were constructed to compare the difference in survival time between two groups.Results Among the 46 recipients,the incidence rate of IR is 67.39%(31/46).In univariate analysis,advanced age,longer warm ischemia time,and higher preoperative FBG,BMI,and IL-6 were associated with postoperative IR.Warm ischemia time was an independent risk factor(OR 3.175,95%CI 0.641-1.670,P=0.025),and the recipents who have higher postoperative CRP,IL-6,TAC plasma concentrations and FBG levels were more likely develop IR.IR did not affect recipient survival(Log-rank test:P=0.182).Conclusion Age,BMI,IL-6,FBG,warm ischemia time,CRP and TAC plasma concentrations in recipients are associated with risk of postoperative IR.