CAJ | 학술논문

目的探讨肝移植术后糖尿病(PTDM)发病的危险因素以及供肝脂肪变性对PTDM发病风险的影响.方法回顾性分析2001年4月至2008年12月438例接受肝移植患者的术前、术后的临床资料.采用2006年中华医学会肝脏病学分会制定的非酒精性脂肪性肝病( NAFLD)诊疗指南的组织病理评分标准判定供肝脂肪变性程度,肝功能状态判定采用Child-Pugh评分系统.根据术后空腹血糖将患者分为非PTDM组(n=298,男250例,女48例,平均年龄48岁)与PTDM组(n=140,男120例,女20例,平均年龄50岁).对PTDM可能的危险因素,包括年龄、性别、空腹血糖、体质指数、术前肝功能、供肝脂肪变性、术后抗排异药种类、白细胞介素-2受体拮抗剂(IL-2RA)应用等进行单因素分析.在单因素分析基础上进行logistic多元回归分析.结果非PTDM组供肝脂肪变性者占34.6％ (103/298),PTDM组供肝脂肪变性者占44.3％( 62/140),2组无显著差别(x2=3.83,P=0.05).单因素分析提示术前空腹血糖(F=23.38,P＜0.05)、术前肝功能、IL-2RA、免疫抑制剂类型与PTDM显著相关(x2值分别为7.69、8.30、0.02,均P＜0.05),而供肝脂肪变性与PTDM相关性处于临界水平(x2 =3.83-P=0.05).logistic多元回归分析提示术前空腹血糖异常(OR=1.853-P＜0.01)、供肝脂肪变性(OR=1.80-P＜0.05)可提高PTDM患病风险,而使用IL-2RA(OR=0.43-P＜0.01)可降低PTDM患病风险.结论供肝脂肪变性、术前空腹血糖异常为PTDM的危险因素,而IL-2RA应用则可降低PTDM发生风险,术前肝功能异常可能增加PTDM的发生风险,免疫抑制剂与PTDM的关系有待进一步研究.
목적 탐토간이식술후당뇨병(PTDM)발병적위험인소이급공간지방변성대PTDM발병풍험적영향.방법 회고성분석2001년4월지2008년12월438례접수간이식환자적술전、술후적림상자료.채용2006년중화의학회간장병학분회제정적비주정성지방성간병( NAFLD)진료지남적조직병리평분표준판정공간지방변성정도,간공능상태판정채용Child-Pugh평분계통.근거술후공복혈당장환자분위비PTDM조(n=298,남250례,녀48례,평균년령48세)여PTDM조(n=140,남120례,녀20례,평균년령50세).대PTDM가능적위험인소,포괄년령、성별、공복혈당、체질지수、술전간공능、공간지방변성、술후항배이약충류、백세포개소-2수체길항제(IL-2RA)응용등진행단인소분석.재단인소분석기출상진행logistic다원회귀분석.결과 비PTDM조공간지방변성자점34.6％ (103/298),PTDM조공간지방변성자점44.3％( 62/140),2조무현저차별(x2=3.83,P=0.05).단인소분석제시술전공복혈당(F=23.38,P＜0.05)、술전간공능、IL-2RA、면역억제제류형여PTDM현저상관(x2치분별위7.69、8.30、0.02,균P＜0.05),이공간지방변성여PTDM상관성처우림계수평(x2 =3.83-P=0.05).logistic다원회귀분석제시술전공복혈당이상(OR=1.853-P＜0.01)、공간지방변성(OR=1.80-P＜0.05)가제고PTDM환병풍험,이사용IL-2RA(OR=0.43-P＜0.01)가강저PTDM환병풍험.결론 공간지방변성、술전공복혈당이상위PTDM적위험인소,이IL-2RA응용칙가강저PTDM발생풍험,술전간공능이상가능증가PTDM적발생풍험,면역억제제여PTDM적관계유대진일보연구.
Objective To discuss the risk factors of post-transplant diabetes mellitus (PTDM) in patients undergoing liver transplantation,especially donor liver steatosis.Methods Retrospectively analyze the data of 438 patients who received orthotopic liver transplantation from April,2001 to December,2008.The grade of donor liver steatosis was measured by histopathologic grading of non-alcoholic fatty liver disease in the guideline issued by Chinese Society of Hepatology.The donor liver function was evaluated by ChildPugh grade system.According to the level of fasting plasma glucose after the operation,the patients were divided into non-PTDM group (n =298,250 males and 48 females,mean age 48 years) and PTDM group (n =140,120 males and 20 females,mean age 50 years).Univariate analysis was used to analyze the possible risk factors of PTDM,such as age,gender,fasting plasma glucose,body mass index,liver function before operation,steatosis of donor liver,anti-rejection drug,interleukin-2 receptor antagonist ( IL-2RA )use.Multivariate logistic regression was employed based on the univariate analysis.Results There were 103 cases of donor liver steatosis in 298 non-PTDM patients (34.6％ ),and 62 donor liver steatosis in 140PTDM patients (44.3％ ),no significant differences was found between the two groups(x2 =3.83,P =0.05 ).Univariate analysis showed that fasting plasma glucose before operation( F =23.38,P ＜0.05 ),liver function before operation,the use of IL-2RA and calcineurin inhibitor were significantly related to PTDM (x2values was 7.69,8.30,0.02,respectively; all P＜0.05),but donor liver steatosis was at the critical level in relation to PTDM (x2 =3.83,P =0.05 ).While multivariate logistic regression indicated abnormal fasting plasma glucose before operation and donor liver steatosis had a positive relation with PTDM,the odds ratio (OR) value was 1.853 ( P ＜ 0.01 ) and 1.80 ( P ＜ 0.05 ),respectively.And the use of IL-2RA was negatively related with PTDM with a OR value of 0.43 (P ＜ 0.01 ).Conclusions Abnormal fasting plasma glucose before operation and donor liver steatosis are risk factors of PTDM,and use of IL-2RA can reduce the risk of PTDM; abnormal liver function before operation may increase the risk of PTDM,while the correlation between calcineurin inhibitor and PTDM needs further studv.