肾移植后糖代谢异常患者血糖变化的影响因素

Influencing Factors of Blood Glucose Changes in Patients with Abnormal Glucose Metabolism after Kidney Transplantation

摘要: 目的：新发糖尿病是实体器官移植后常见的严重并发症。患有移植后糖尿病(PTDM)的肾移植受者发生心血管事件及其他不良后果的风险有所增加。本实验旨在研究引起肾移植后高血糖患者最终血糖出现不同结局的影响因素，为预防肾移植后糖尿病提供理论支持。方法：收集2013~2018年在青岛大学附属医院接受肾移植手术后出现糖代谢异常的患者178例。根据术后空腹血糖是否恢复正常，分为一过性糖尿病组和移植后糖尿病组。分析肾移植后糖代谢异常患者血糖难以恢复的影响因素。结果：在178名出现移植后糖代谢异常的患者中，血糖恢复正常者共68例，血糖持续不恢复者共110例。单因素分析结果显示，年龄、体重指数、术前空腹血糖、急性排斥反应、多囊肾、糖尿病家族史在移植后糖尿病组均高于一过性糖尿病组(P < 0.05)。多因素Logistic回归分析显示，年龄、术前空腹血糖、急性排斥反应、多囊肾、糖尿病家族史是肾移植后高血糖无法恢复的影响因素。结论：年龄、术前空腹血糖、急性排斥反应、多囊肾、糖尿病家族史是肾移植后糖代谢异常患者血糖无法恢复的影响因素。

Abstract: Objective: New diabetes mellitus is a common serious complication after solid organ transplantation. Compared with patients without diabetes, kidney transplant recipients with post-transplant diabetes mellitus (PTDM) had an increased risk of fatal and non-fatal cardiovascular events and other adverse outcomes, including infection, decreased patient survival, graft rejection, and accelerated graft injury. Identifying high-risk patients and taking measures to reduce the development of PTDM may improve the long-term prognosis of patients and grafts. The purpose of this research was to study the influencing factors of different blood glucose outcomes in patients with hyperglycemia after kidney transplantation, so as to provide theoretical support for the prevention of diabetes after kidney transplantation. Methods: A total of 178 patients with abnormal glucose metabolism after kidney transplantation in affiliated hospital of Qingdao university from 2013 to 2018 were collected. According to whether the fasting blood glucose returned to normal after the operation, it was divided into the transient diabetes group and the post-transplantation diabetes group. Univariate analysis was performed first to select meaningful independent variables, and then multivariate Logistic regression analysis was performed to analyze the factors affecting the recovery of blood glucose in patients with abnormal glucose metabolism after kidney transplantation. Results: Among 178 patients with abnormal glucose metabolism after transplantation, 68 patients had their blood glucose restored to normal, and 110 patients did not. The results of univariate analysis showed that age, body mass index, preoperative fasting glucose, acute rejection, polycystic kidney disease, and family history of diabetes were all higher in the post-transplant diabetes group than in the transient diabetes group (P < 0.05). Multivariate Logistic regression analysis showed that age, preoperative fasting blood glucose, acute rejection, polycystic kidney disease, and family history of diabetes were the influencing factors for the failure of hyperglycemia after renal transplantation. Conclusion: Age, preoperative fasting blood glucose, acute rejection, polycystic kidney disease, and family history of diabetes mellitus are the influencing factors for blood glucose recovery in patients with abnormal glucose metabolism after kidney transplantation.