肾移植后糖尿病危险因素的研究现状

肾移植后糖尿病危险因素的研究现状

张思杰

成都双流国际机场股份有限公司医疗救护中心  四川 成都 610200

移植后糖尿病（Post-Transplant Diabetes Mellitus，PTDM）即器官移植术后的慢性高血糖症，肾移植术1年后PTDM的发生率波动在9%～39% [1]，发生率高，与传统的2型糖尿病危险因素有关，也与移植术后糖皮质激素和免疫抑制剂的使用有关[2,3]。本文对近年来PTDM危险因素的相关研进展进行文献复习并综述。

1 手术前危险因素

研究发现移植术前代谢综合征、空腹血糖受损、肥胖、高龄是PTDM发生的独立危险因素[4,5]，一篇Meta分析结果显示：术前体重指数（Body Mass Index，BMI）越高，术后糖尿病的发生率越高[6]。丙型肝炎病毒（Hepatitis C Virus，HCV）感染和常染色体显性多囊肾病（Autosomal dominant polycystic kidney disease，ADPKD)也被证明与PTDM的发生有关[2,7]。

2 手术后危险因素

Oliver等人[8]研究发现，术后持续糖皮质激素治疗和术后早期（8天）停用糖皮质激素两组中，术后1年PTDM的发生率分别为39%和25%（P＜0.05）。目前肾移植术后用药中包括钙调磷酸酶抑制剂（CNIs），CNIs包括环孢素A（Cyclosporine A ，CsA）和他克莫司（Tacrolimus，FK506），Laurence等人[9]发现CNIs剂量偏低组PTDM的发生率偏低(17% VS 31%，P = 0.02)，认为CNIs与PTDM的发生有剂量依赖性。

3 总结

综上所述，PTDM的发生与传统的2型糖尿病发病危险因素有关，也与术后用药有密切关系，移植前患者应该普遍筛查糖尿病，术后患者应定期复查血糖，做到对PTDM早发现、早诊断、早治疗，减少远期并发症发生。

参考文献

[1]Yates C J, Fourlanos S, Hjelmesaeth J, et al. New-Onset Diabetes After Kidney Transplantation-Changes and Challenges[J]. American Journal of Transplantation, 2012, 12(4): 820-828.

[2]Jenssen T, Hartmann A. Post-transplant diabetes mellitus in patients with solid organ transplants[J]. Nature reviews, Endocrinology, 2019, 15(3): 172-188.

[3]Santosh Kumar D S P D. An observational Prospective Study to Evaluate the Preoperative Risk Factors of New-onset Diabetes Mellitus after Renal Transplantation in a Tertiary Care Centre in Eastern India[J]. Indian Journal of Endocrinology and Metabolism, 2018, 22(5): 610-615.

[4]Cai R, Wu M, Xing Y. Pretransplant metabolic syndrome and its components predict post-transplantation diabetes mellitus in Chinese patients receiving a first renal transplant[J]. TherClin Risk Manag, 2019, 15: 497-503.

[5]Dedinska I, Granak K, Vnucak M, et al. Role of sex in post-transplant diabetes mellitus development: Are men and women equal?[J]. J Diabetes Complications, 2019, 33(4): 315-322.

[6]Lafranca J A, Ijermans J N, Betjes M G, et al. Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis[J]. BMC Med, 2015, 13: 111.

[7]Cheungpasitporn W, Thongprayoon C, Vijayvargiya P, et al. The Risk for New-Onset Diabetes Mellitus after Kidney Transplantation in Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis[J]. Can J Diabetes, 2016, 40(6): 521-528.

[8]Thomusch O, Wiesener M, Opgenoorth M, et al. Rabbit-ATG or basiliximab induction for rapid steroid withdrawal after renal transplantation (Harmony): an open-label, multicentre, randomised controlled trial[J]. The Lancet, 2016, 388(10063): 3006-3016.

[9]Chan L, Andres A, Bunnapradist S, et al. Renal Function and NODM inDe Novo Renal Transplant Recipients Treated with Standard and Reduced Levels of FK506rolimus in Combination with EC-MPS[J]. Journal of Transplantation, 2012, 2012: 1-9.