成人原位肝移植术后糖尿病发生的危险因素分析

An analysis of risk factors for the development of diabetes mellitus after orthotopic liver transplantation in adults

目的探讨成人原位肝移植术后糖尿病(post-transplant diabetes mellitus,PTDM)发生的危险因素。方法选择2017年7月1日—2023年1月31日我院原位肝移植手术患者293例,根据术后是否发生糖尿病分为PTDM组(66例)和非PTDM组(227例),收集两组患者的临床资料,对有差异的指标行多因素logistic回归分析成人PTDM发生的独立危险因素。绘制两组患者的Kaplan-Meier生存曲线,分析PTDM发生对患者生存率的影响。结果患者PTDM的发生率为22.5%。两组患者的年龄、术前空腹血糖水平、术前血清总胆固醇水平、术前血清低密度脂蛋白水平、术后应用环孢素患者构成比、术后应用抗免疫排斥方案C(单用环孢素/环孢素联合麦考酚酯或西罗莫司)或D(单用麦考酚酯或西罗莫司)患者构成比、高血压史患者构成比差异显著(t=-3.191,U=-5.668~-2.559,χ^(2)=3.922~5.689,P<0.05)。多因素logistic回归分析显示,年龄>46岁、高血压史、术前空腹血糖>6.1 mmol/L、术前血清低密度脂蛋白水平>3.12 mmol/L、术后应用抗免疫排斥方案C(单用环孢素/环孢素联合麦考酚酯或西罗莫司)是PTDM发生的独立危险因素。生存曲线分析结果显示,PTDM发生可降低患者的5年生存率(P<0.05)。结论年龄>46岁、高血压史、术前空腹血糖>6.1 mmol/L、术前血清低密度脂蛋白水平>3.12 mmol/L、术后单用环孢素/环孢素联合麦考酚酯或西罗莫司的抗免疫排斥方案是成人PTDM发生的独立危险因素。

Objective To investigate risk factors for the development of post-transplant diabetes mellitus(PTDM)in patients undergoing orthotopic liver transplantation.Methods We included 293 patients who underwent orthotopic liver transplantation at The Affiliated Hospital of Qingdao University from July 1,2017 to January 31,2023.According to whether PTDM occurred,the patients were divided into PTDM group(n=66)and non-PTDM group(n=227).Significantly different clinical para-meters between the two groups were included in a multivariable logistic regression model to determine independent risk factors for PTDM.The impact of PTDM on the survival rate of the patients was analyzed using a Kaplan-Meier survival curve.Results The incidence rate of PTDM among the patients was 22.5%.The PTDM group and non-PTDM group differed significantly in age,the percentage of patients with a history of hypertension,preoperative fasting blood glucose level,preoperative serum total cholesterol level,preoperative serum low-density lipoprotein level,the percentage of patients treated with cyclosporine after surgery,and the percentage of patients treated with anti-rejection regimen C(cyclosporine alone or combined with mycophenolate or sirolimus)or D(mycophenolate or sirolimus alone)after surgery(t=-3.191,U=-5.668--2.559,χ^(2)=3.922-5.689,P<0.05).The multivariable logistic regression analysis showed that age>46 years,a history of hypertension,preoperative fasting blood glucose level>6.1 mmol/L,preoperative serum low-density lipoprotein level>3.12 mmol/L,postoperative use of anti-rejection regimen C(cyclosporine alone or combined with mycophenolate or sirolimus)were independent risk factors for the occurrence of PTDM(P<0.05).The survival curve showed that the occurrence of PTDM significantly decreased the 5-year survival rate of the patients(P<0.05).Conclusion Age>46 years,a history of hypertension,preoperative fasting blood glucose level>6.1 mmol/L,preoperative serum low-density lipoprotein level>3.12 mmol/L,and postoperative anti-rejection treatment with cyclosporine alone or combined with mycophenolate or sirolimus are independent risk factors for adult PTDM.