肾移植后糖尿病的早期影响因素及预防策略

Early influencing factors and prevention strategies of diabetes after renal transplantation

目的通过分析公民逝世后器官捐献(organ donation after the death of a citizen,DCD)肾移植受者并发移植后糖尿病(post transplantation diabetes mellitus,PTDM)的早期影响因素,探讨优化管理策略,从而改善移植物和受者长期存活。方法回顾性分析山西省第二人民医院肾移植中心2015年1月1日至2020年5月1日的肾移植受者448例,分为PTDM组(211例)和非PTDM组(237例),随访至2022年10月1日,随访时间(53.4±16.9)个月。收集术前及术后共22项因素的相关资料,采用回归分析、t检验、生存分析的统计方法,明确PTDM影响因素,同时比较两组早期移植肾功能及人/肾存活率。结果肾移植术后6月PTDM发生率为33.6(211/628)%。早期独立危险因素有:体质指数(body mass index,BMI)(OR=1.025)、急性排斥反应(OR=2.25)、给予降糖治疗(OR=6.041)、空腹血糖(fasting blood glucose,FBG)(OR=3.167)。早期独立保护因素有:血清镁(OR=0.28)、血清25羟维生素D(25(OH)D)(OR=0.908)。两组受者早期移植肾功能、人/肾存活率差异均无统计学意义(P>0.05)。结论肾移植受者围手术期血糖高于目标值时,应尽早使用胰岛素保护胰岛功能,通过降低排斥反应、控制体重、纠正低镁血症、改善维生素D不足等策略,从而降低PTDM的发生率。科学有效管理多种危险因素和保护因素,可提高PTDM受者移植肾功能及人/肾存活率。

Objective To investigate the optimal management strategies to improve the long-term survival of the transplant and recipient.Methods A retrospective analysis was performed on 448 kidney transplant recipients from the Kidney Transplant Center of Shanxi Second People’s Hospital from Jan.1,2015 to May.1,2020,who were divided into PTDM group(211 cases)and non-PTDM group(237 cases).The average follow-up time was(53.4±16.9 months)until Oct.1,2022.The relevant data of 22 factors were collected before and after operation.Regression analysis,t test and survival analysis were used to identify the influencing factors of PTDM.At the same time,the early renal transplantation function and human/kidney survival rate were compared between the two groups.Results The incidence of PTDM at 6 months after renal transplantation was 33.6%.Early independent risk factors were body mass index(BMI)(OR=1.025),acute rejection(OR=2.25),hypoglycemic therapy(OR=6.041),fasting blood glucose(FBG)(OR=3.167).Early independent protective factors were serum magnesium(OR=0.28)and serum 25 hydroxyvitamin D(25(OH)D)(OR=0.908).There were no significant differences in early renal function and human/kidney survival between the two groups(P>0.05).Conclusions When the perioperative blood glucose of kidney transplant recipients is higher than the target value,insulin should be used as soon as possible to protect the islet function,and the incidence of PTDM should be reduced by reducing rejection,controlling weight,correcting hypomagnesia,improving vitamin D deficiency and other strategies.Scientific and effective management of a variety of risk factors and protective factors to improve the transplant kidney function and human/kidney survival rate of PTDM recipients.