CAJ | 학술논문

目的探讨肾移植术后存活1年以上患者空腹血糖变化规律及其对预后的影响.方法收集446例1993年1月至2008年12月接受肾移植手术且移植肾存活1年以上患者的临床资料,根据术前空腹血糖,将患者分为移植前糖尿病、空腹血糖受损、空腹血糖正常3组,观察各组术后空腹血糖变化规律.对428例术前非糖尿病患者,根据空腹血糖分析术后移植后糖尿病( PTDM)发生及转归,比较持续性PTDM和一过性PTDM临床特点,并比较PTDM组和非PTDM组术后并发症及生存率的差异.结果肾移植后患者血糖整体呈先升高后下降的趋势.428例术前非糖尿病患者,共有87例(20.3％)发生PTDM,其中15例(占总PTDM的17.2％)在随访中转为空腹血糖正常或空腹血糖受损.与持续性PTDM相比,一过性PTDM患者急性排斥反应发生率更高(P=0.043).与非PTDM组相比,PTDM组术后感染、高血压和脂代谢紊乱发生率更高(P＜0.05).平均随访(5.65±3.68)年,两组患者生存率和生存时间未见明显差异.结论 PTDM并非持续存在,在病程中有可能转为空腹血糖受损或空腹血糖正常.急性排斥反应是一过性血糖升高的危险因素.肾移植后PTDM患者术后更容易发生感染、高血压、高血脂等并发症,但本组术后随访,存活率未受明显影响.
목적 탐토신이식술후존활1년이상환자공복혈당변화규률급기대예후적영향.방법 수집446례1993년1월지2008년12월접수신이식수술차이식신존활1년이상환자적림상자료,근거술전공복혈당,장환자분위이식전당뇨병、공복혈당수손、공복혈당정상3조,관찰각조술후공복혈당변화규률.대428례술전비당뇨병환자,근거공복혈당분석술후이식후당뇨병( PTDM)발생급전귀,비교지속성PTDM화일과성PTDM림상특점,병비교PTDM조화비PTDM조술후병발증급생존솔적차이.결과 신이식후환자혈당정체정선승고후하강적추세.428례술전비당뇨병환자,공유87례(20.3％)발생PTDM,기중15례(점총PTDM적17.2％)재수방중전위공복혈당정상혹공복혈당수손.여지속성PTDM상비,일과성PTDM환자급성배척반응발생솔경고(P=0.043).여비PTDM조상비,PTDM조술후감염、고혈압화지대사문란발생솔경고(P＜0.05).평균수방(5.65±3.68)년,량조환자생존솔화생존시간미견명현차이.결론 PTDM병비지속존재,재병정중유가능전위공복혈당수손혹공복혈당정상.급성배척반응시일과성혈당승고적위험인소.신이식후PTDM환자술후경용역발생감염、고혈압、고혈지등병발증,단본조술후수방,존활솔미수명현영향.
Objective To explore the long-term fluctuation of fasting plasma glucose (FPG) and its effect on prognosis in patients surviving for more than 1 year after renal transplantation.Methods Four hundred and forty-six patients underwent kidney transplantation from January,1993 to December,2008.According to preoperative FPG levels,patients were divided into diabetic,impaired fasting glucose (IFG),and normal fasting glucose (NFG)groups. The changing trend of FPG level was observed and analyzed. For 428 non-diabetic patients before transplantation,the prevalence and different outcomes of post-transplantation diabetes( PTDM ) according to FPG after transplantation were analyzed.The characteristics of the patients with persistent PTDM ( P-PTDM ) and transient PTDM (T-PTDM) were compared.The incidence of complications and patient survival between the PTDM group and non-PTDM groups were also compared.Results FPG level was increased early and then decreased in patients after renal transplantation.Of the 428 patients,87 developed into PTDM ( 20.3％ ) including 15 T-PTDM patients ( 17.2％ of total PTDM ),who eventually recovered to NFG or IFG.Compared with P-PTDM group,the incidence of acute rejection episodes was higher for T-PTDM ( P =0.043 ).The incidence of infections,hypertension,and dyslipidemia within the first year,was higher in PTDM group compared with non-PTDM group but patient survival was not different within a mean follow-up of ( 5.65 ± 3.68 ) years.Conclusion PTDM will not be permanent and may recover to NFG or IFG in the course of the disease.Acute rejections are associated with the onset of T-PTDM.The overall patient survival is not affected by PTDM,although complications,such as infections,hypertention,and hyperlipidemia are more frequently encountered in PTDM patients.