中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2014年
4期
221-224
,共4页
章保勇%胡盛寿%黄洁%宋云虎%王巍%廖中凯
章保勇%鬍盛壽%黃潔%宋雲虎%王巍%廖中凱
장보용%호성수%황길%송운호%왕외%료중개
心脏移植%糖尿病%危险因素%预后
心髒移植%糖尿病%危險因素%預後
심장이식%당뇨병%위험인소%예후
Heart transplantation%Diabetes mellitus%Risk factors%Prognosis
目的 探讨心脏移植受者移植后新发糖尿病(PTDM)的发生情况、其独立危险因素及其对受者中期存活的影响.方法 从单中心自2004年6月至2012年5月完成的301例心脏移植受者中选取术后存活时间≥6个月且术前无糖尿病的患者226例进行随访,随访中位时间为41个月.按美国糖尿病协会2006年修订版中PTDM的诊断标准将研究对象分为PTDM组(53例)和非PTDM组(NPTDM组,173例).对可能影响PTDM发生的术前和术后因素进行单因素分析,再利用Logistic回归分析模型进行独立危险因素分析,并绘制移植受者的Kaplan-Meier生存曲线.结果 226例患者PTDM发生率为23.5％.Logistic回归分析得到的PTDM发生独立危险因素为年龄(相对危险度=1.05,95％可信区间为1.01～2.30,P=0.012)和一级亲属糖尿病家族史(相对危险度=1.90,95％可信区间为1.04～4.10,P=0.032).术后1、3和5年PTDM组存活率分别为100.0％、98.0％和89.8％,NPTDM组存活率分别为98.2％、94.2％和92.4％.Log-rank检验显示,PTDM组和NPTDM组的生存曲线中存活率的差异无统计学意义(P＞0.05).结论 PTDM是心脏移植术后常见的并发症,患者年龄和一级亲属糖尿病家族史是其发病的独立危险因素.PTDM患者经相应治疗后,中期生存未受明显影响.
目的 探討心髒移植受者移植後新髮糖尿病(PTDM)的髮生情況、其獨立危險因素及其對受者中期存活的影響.方法 從單中心自2004年6月至2012年5月完成的301例心髒移植受者中選取術後存活時間≥6箇月且術前無糖尿病的患者226例進行隨訪,隨訪中位時間為41箇月.按美國糖尿病協會2006年脩訂版中PTDM的診斷標準將研究對象分為PTDM組(53例)和非PTDM組(NPTDM組,173例).對可能影響PTDM髮生的術前和術後因素進行單因素分析,再利用Logistic迴歸分析模型進行獨立危險因素分析,併繪製移植受者的Kaplan-Meier生存麯線.結果 226例患者PTDM髮生率為23.5％.Logistic迴歸分析得到的PTDM髮生獨立危險因素為年齡(相對危險度=1.05,95％可信區間為1.01～2.30,P=0.012)和一級親屬糖尿病傢族史(相對危險度=1.90,95％可信區間為1.04～4.10,P=0.032).術後1、3和5年PTDM組存活率分彆為100.0％、98.0％和89.8％,NPTDM組存活率分彆為98.2％、94.2％和92.4％.Log-rank檢驗顯示,PTDM組和NPTDM組的生存麯線中存活率的差異無統計學意義(P＞0.05).結論 PTDM是心髒移植術後常見的併髮癥,患者年齡和一級親屬糖尿病傢族史是其髮病的獨立危險因素.PTDM患者經相應治療後,中期生存未受明顯影響.
목적 탐토심장이식수자이식후신발당뇨병(PTDM)적발생정황、기독립위험인소급기대수자중기존활적영향.방법 종단중심자2004년6월지2012년5월완성적301례심장이식수자중선취술후존활시간≥6개월차술전무당뇨병적환자226례진행수방,수방중위시간위41개월.안미국당뇨병협회2006년수정판중PTDM적진단표준장연구대상분위PTDM조(53례)화비PTDM조(NPTDM조,173례).대가능영향PTDM발생적술전화술후인소진행단인소분석,재이용Logistic회귀분석모형진행독립위험인소분석,병회제이식수자적Kaplan-Meier생존곡선.결과 226례환자PTDM발생솔위23.5％.Logistic회귀분석득도적PTDM발생독립위험인소위년령(상대위험도=1.05,95％가신구간위1.01～2.30,P=0.012)화일급친속당뇨병가족사(상대위험도=1.90,95％가신구간위1.04～4.10,P=0.032).술후1、3화5년PTDM조존활솔분별위100.0％、98.0％화89.8％,NPTDM조존활솔분별위98.2％、94.2％화92.4％.Log-rank검험현시,PTDM조화NPTDM조적생존곡선중존활솔적차이무통계학의의(P＞0.05).결론 PTDM시심장이식술후상견적병발증,환자년령화일급친속당뇨병가족사시기발병적독립위험인소.PTDM환자경상응치료후,중기생존미수명현영향.
Objective To determine the incidence and independent risk factors of new onset posttransplantation diabetes mellitus (PTDM) and its prognostic value in medium term survival rate in heart transplant recipients.Method We performed a retrospective study on all heart transplant recipients in a single center from June 2004 to May 2012,and selected 226 patients without DM in pretransplant period with median 41-month follow-up.According to the diagnostic criteria of the American Diabetes Association (ADA) 2006 revised edition of PTDM,the selected patients were divided into PTDM (group 1) and NPTDM (group 2).Univariate analysis and logistic regression analysis were used to determine preoperative and postoperative risk factors responsible for PTDM.Kaplan-Meier method and Log rank test were used for survival analysis.Result Of the 226 patients,53 case developed DM (23.5 ％).The multivariate analysis identified the following as predictive factors for the development of PTDM:age ([OR]:1.05,95％ CI:1.01 ～2.30,P =0.012),and first-degree relatives of family history of DM ([OR]:1.90,95％ CI:1.04～4.10,P =0.032).The 1-,3-and 5-year survival rate in PTDM patients post-transplantation was 100.0％,98.0％ and 89.8％,and that in NPTDM patients was 98.2％,94.2％ and 92.4％,respectively.Log Rank test displayed no significant difference between two survival curves (P＞0.05).Conclusion PTDM is a frequent comorbidity after HT.Age and first-degree relatives of family history of DM were significant and independent risk factors for the development of PTDM during the follow-up period.By appropriate treatment,the medium-term survival rate of patients with PTDM was unaffected.
