F.Cr. Mazali, Cr.A. Lalli, G. Alves-Filho, M. Mazzali 

  移植后糖尿病（PTDM）在移植手术之后是常见的，同时也与他克莫司（TAC）和类固醇疗法有关。本研究的目的是分析PTDM的发病率以及相关的风险因素。

方法：我们选择了采用TAC、霉酚酸酯（MMF）和类固醇疗法的肾移植受体。在选择研究对象时采用的排除标准是受体年龄小于18岁、有糖尿病病史、肾移植/胰腺移植受体和/或接受环孢素或西罗莫司的受体。PTDM被界定为葡萄糖水平>126 mg/dL、有/没有接受药物治疗。

结果：在被选定的67名患者中，18例（26.8%）患者在移植术后2个月以内出现了PTDM。与葡萄糖水平正常的患者相比，PTDM组患者的年龄更大、男性、移植肾来自于尸供体、移植前葡萄糖水平更高。两组患者的移植肾肾功能和每日TAC或类固醇的使用剂量并没有区别。尽管PTDM组患者TAC的每千克剂量更低，但是PTDM患者第一个月的TAC低谷水平却高于葡萄糖水平正常的患者。经过一年的术后随访，PTDM患者的体重增加数和每日TAC的每千克使用剂量更低。对潜在风险因素的分析结果显示，PTDM患者感染丙型肝炎病毒的概率更高，出现HLA DR13的概率也更大。

结论：本研究中移植受体在术后早期出现PTDM的发病率为26.8%。风险因素包括高龄、男性、移植肾来自于尸供体、丙型肝炎病毒感染、移植前葡萄糖水平较高，以及移植术后一个月TAC低谷水平较高。

Posttransplant Diabetes Mellitus: Incidence and Risk Factors
F.Cr. Mazali, Cr.A. Lalli, G. Alves-Filho, M. Mazzali

Posttransplant diabetes mellitus (PTDM) is common post transplantation and is associated with tacrolimus (TAC) and steroid therapy. The aim of the present study was to analyze the incidences of PTDM and associated risk factors.

Methods：We selected renal transplant recipients treated with TAC, mycophenolate mofetil (MM), and steroids. Exclusion criteria were recipients <18 years old, history of diabetes, recipients of kidney/pancreas, and/or those receiving cyclosporine or sirolimus. PTDM was defined as glucose >126 mg/dL, with or without drug therapy.

Results：Among 67 patients who fulfilled the inclusion criteria, 18 (26.8%) developed PTDM within 2 months of transplantation. Compared with normal glucose patients, the PTDM group was older, male, received a kidney from deceased donors, and showed higher pretransplant glucose levels. No differences were noticed in renal function or daily dose of TAC or steroids. However, TAC trough levels in the first month were higher among the PTDM group, despite the lower dose per kilogram. After 1 year of follow-up, weight gain as well as daily TAC per kilogram dose was less among PTDM patients. Analysis of potential risk factors showed a higher incidence of hepatitis C virus infection in the PTDM group, as well as a higher frequency of HLA DR13.

Conclusion：The incidence of PTDM diagnosed in the early posttransplant period in the present series was 26.8%. Risk factors included older age, male gender, recipients of kidneys from deceased donors, hepatitis C virus infection, higher pretransplant glucose levels, and higher TAC trough levels during the first month posttransplant.

Volume 40, Issue 3, Pages 764-766 (April 2008)

[责任编辑:刘 聪]