肝移植术后糖尿病的发病率和危险因素分析

The incidence and risk factors analysis of post-transplant diabetes mellitus in liver transplantation

目的:探讨影响肝移植术后糖尿病(PTDM)发生的危险因素,为有效地预防和治疗PTDM提供参考证据。方法:回顾性分析2018年1月1日-2019年3月1日在某院移植中心进行同种异体原位肝移植术的91例移植受者。根据ADA糖尿病诊断指标,将肝移植受者分为PTDM组(18例)与non-PTDM组(73例)。基于统计学分析方法,筛选出影响PTDM发生的危险因素。结果:该院肝移植中心PTDM的1年内累积发生率为19.78%。多因素非条件Logistic回归分析结果显示,肥胖(BMI≥25 kg·m-2)(OR=8.754,95%CI:2.113~36.273,P<0.05)、术前空腹血糖受损(IFG)(OR=4.713,95%CI:1.305~17.027,P<0.05)和ICU停留时间(OR=1.367,95%CI:1.013~1.843,P<0.05)是肝移植受者发生PTDM的独立危险因素。结论:肥胖、术前IFG和ICU停留时间与PTDM的发生存在相关性。为减少PTDM的发生率,针对与PTDM发生相关的危险因素,尽早采取预防和干预措施是关键。

OBJECTIVE To investigate the risk factors for post-transplant diabetes mellitus(PTDM)in liver transplant recipients,and provide reference for the effective prevention and treatment of PTDM.METHODS A retrospective analysis of 91 transplant recipients who underwent allogeneic orthotopic liver transplantation in our transplant center from January 1,2018 to March 1,2019 was performed.According to American Diabetes Association criteria,liver transplant recipients were divided into PTDM group(n=18)and non-PTDM group(n=73).Based on statistical analysis,risk factors effecting the occurrence and development of the PTDM were selected.RESULTS In this study,the cumulative incidence of PTDM in one year was 19.78%.Multivariate unconditional logistic regression analysis showed that obesity(BMI≥25 kg·m-2)(OR=8.754,95%CI:2.113-36.273,P<0.05),pre-transplant impaired fasting glucose(IFG)(OR=4.713,95%CI:1.305-17.027,P<0.05),and length of stay in ICU(OR=1.367,95%CI:1.013-1.843,P<0.05)were independent risk factors of PTDM in liver transplant recipients.CONCLUSION Obesity,pre-transplant IFG and length of stay in ICU were significantly associated with PTDM.To reduce the incidence of PTDM,it is critical to take preventive and intervention measures as early as possible against the risk factors associated with the development of PTDM.