肾移植后糖尿病危险因素分析

Analysis of risk factors for post-transplant diabetes mellitus after kidney transplantation

目的探讨肾移植患者术后并发移植后糖尿病(post-transplant diabetes mellitus,PTDM)的危险因素,为PTDM的预防与治疗提供依据。方法回顾性分析2018年7月至2020年7月行同种异体肾移植术的136例患者的临床资料。按国内糖尿病诊断标准将患者分为PTDM组(空腹血糖≥7.0 mmol/L)和non-PTDM组(空腹血糖<7.0 mmol/L),采用单因素和多因素Logistic回归分析影响PTDM发生的独立危险因素。结果在136例同种异体肾移植患者中,47例发生PTDM,PTDM发生率为34.6%。多因素Logistic回归分析显示,年龄≥45岁(OR=3.019,95%CI=1.123~8.115,P=0.028)、体重指数(body mass index,BMI)≥25 kg/m2(OR=3.868,95%CI=1.253~11.941,P=0.019)、移植后发生急性排斥反应(OR=4.620,95%CI=1.339~15.940,P=0.015)、移植后使用他克莫司(OR=4.853,95%CI=1.49~15.807,P=0.009)均为肾移植术后发生PTDM的独立危险因素(OR>1,P<0.05)。结论年龄≥45岁、BMI≥25 kg/m2、移植后发生急性排斥反应、移植后使用他克莫司的肾移植患者术后发生PTDM的风险明显增加。

Objective To explore the risk factors of post-transplant diabetes mellitus(PTDM)in patients with kidney transplantation,to provide evidence for the prevention and treatment of PTDM.Methods The clinical data of 136 patients who underwent allogeneic kidney transplantation from July 2018 to July 2020 were retrospectively analyzed.The patients were divided into PTDM group(fasting blood glucose≥7.0 mmol/L)and non-PTDM group(fasting blood glucose<7.0 mmol/L)according to the domestic diabetes diagnostic criteria.Univariate and multivariate Logistic regression were used to analyze the independent risk factors of PTDM.Results Among 136 renal transplant patients,47 cases were diagnosed with PTDM,and the incidence of PTDM was 34.6%.Multivariate Logistic regression analysis showed:age≥45 years old(OR=3.019,95%CI=1.123~8.115,P=0.028),body mass index(BMI)≥25 kg/m2(OR=3.868,95%CI=1.253~11.941,P=0.019),acute rejection after transplantation(OR=4.620,95%CI=1.339~15.940,P=0.015),use of tacrolimus after transplantation(OR=4.853,95%CI=1.49~15.807,P=0.009)were independent risk factors for PTDM after kidney transplantation(OR>1,P<0.05).Conclusion The risk of PTDM increased significantly in kidney transplant patients with age≥45 years old,BMI≥25 kg/m2,acute rejection after transplantation and use of tacrolimus after transplantation.