摘要
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,x2=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.
Abstract
Objective To investigate risk factors for the development of post-transplant diabetes mellitus(PTDM)in pa-tients undergoing orthotopic liver transplantation.Methods We included 293 patients who underwent orthotopic liver transplan-tation at The Affiliated Hospital of Qingdao University from July 1,2017 to January 31,2023.According to whether PTDM oc-curred,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 choles-terol 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,x2=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,pre-operative 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.
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