肾移植术后糖尿病的临床危险因素分析及预测模型建立

Clinical risk factors and prediction modeling of post-transplantation diabetes mellitus in kidney recipients

目的探讨肾移植术后糖尿病(post-transplantation diabetes mellitus,PTDM)发生的临床危险因素并构建风险预测模型。方法回顾性分析2018年10月到2019年8月在浙江大学医学院附属第一医院行肾移植手术305例受者的临床资料和术后床旁血糖数据。根据是否发生PTDM,将受者分为PTDM组(34例)和非PTDM组(271例),通过单因素和多因素logistic回归分析筛选PTDM发生的危险因素并建立PTDM预测模型。结果全部305例受者PTDM的发生率为11.15%(34/305)。logistic回归分析显示,尸体供肾移植、年龄≥40岁、女性、术前糖化血红蛋白(pre-hemoglobin A1c,Pre-HbA1c)水平、术后床旁血糖值≥11.1 mmol/L为PTDM发生的相关因素。其中,女性(OR=3.13,95%CI:1.28~7.61)、Pre-HbA1c水平(OR=2.05,95%CI:1.12~3.74)、术后第2或第3天下午4时血糖≥11.1 mmol/L(OR=19.08,95%CI:4.34~83.87)是PTDM发生的危险因素。PTDM预测模型曲线下面积为0.86(95%CI:0.79~0.93),约登指数为0.65,敏感度为82.8%,特异性为82.3%。结论女性、Pre-HbA1c水平、术后第2或第3天下午4时血糖≥11.1 mmol/L是PTDM发生的危险因素。该预测模型具有良好的预测价值,有利于临床早期干预,降低PTDM的发病率。

Objective To explore the clinical risk factors of post-transplantation diabetes mellitus(PTDM)and establish a risk prediction model in kidney recipients.Methods The clinical data and postoperative bedside measurements of blood glucose(BG)were retrospectively reviewed for 305 renal transplant recipients at First Affiliated Hospital of Zhejiang University School of Medicine from October 2018 to August 2019.According to whether or not PTDM occurred,they were assigned into two groups of PTDM(n=34)and non-PTDM(n=271).Risk factors were screened through single/multi-factor Logistic regression and PTDM prediction model was established.Results The incidence rate of PTDM was 11.15%(34/305).Logistic regression analysis indicated that deceased donor,age≥40 years,female,pre-hemoglobin A1c(Pre-HbA1c)and postoperative bedside BG value≥11.1 mmol/L were the correlated factors for the occurrence of PTDM.Among them,female(OR=3.13,95%CI:1.28-7.61),Pre-HbA1c(OR=2.05,95%CI:1.12-3.74)and BG≥11.1 mmol/L at 4pm Day 2/3 post-operation(OR=19.08,95%CI:4.34-83.87)were risk factors for the occurrence of PTDM,The area under the model curve was 0.86(95%CI:0.79-0.93)with a Jordan index of 0.65,a sensitivity of 82.8%and a specificity of 82.3%.Conclusions Female,Pre-HbA1c and fasting BG at 4 pm Day 2/3 post-operation≥11.1 mmol/L are risk factors for the occurrence of PTDM.The prediction model has a decent predictive value.It is conducive to early clinical interventions and lowering the incidence rate of PTDM.