肝移植术后代谢综合征及危险因素分析

摘要

目的 研究肝移植术后代谢综合征(metabolic syndrome,MS)及相关症状在肝移植长期生存者中的发生率与危险因素.方法 参照2005年美国心脏协会修订后的美国国家胆固醇教育计划成人治疗方案第3次报告(NCEP-ATPⅢ)标准,评估肝移植术后生存期≥5年的102例受体MS的发生率.选择手术年龄＞50岁、男性、吸烟史、术前指标肥胖、高血压、糖尿病(DM)、高甘油三酯血症(TG)、低高密度脂蛋白血症(HDL)等因素,用Logistic回归分析其中的危险因素.结果 102例肝移植受体中,肥胖、高血压、DM、低HDL、高TG的发生率在术后明显高于术前.术前与术后MS的发生率分别为29.3％及51.9％.术后MS与非MS组相比,术前肥胖、DM、高血压、高TG、高龄、男性、吸烟史更多见于MS组.结论 MS高发于长期生存的肝移植受体人群中.高龄(＞50岁)、术前肥胖及术前DM为发生肝移植术后代谢综合征的独立危险因素.%Objective To evaluate the prevalence and risk factors of posttransplantation metabolic syndrome(PTMS)in liver transplant recipients.Methods According to NCEP-ATP Ⅲ(2001)standard,we assessed for the presence of PTMS in 102 transplant recipients which have lived ≥ 5 yesrs after liver transplantation.Age ≥ 50 years,the male sex,history of smoking,preoperative obesity,preoperative hypertension,preoperative diabetes,and preoperative hypertriglyceridemia were selected for evaluation.Predictors for PTMS were tested using Logistic regression analysis.Results Among 102 patients assessed,the prevalence of PTMS was 51.9％ compared with 29.3％ pretransplant level.Obesity(body mass index ＞ 28 kg/m2),hypertriglyceridemia(＞ 1.7 mmol/L),high-density lipoprotein cholesterol ＜ 1.0 mmol/L(men)or ＜ 1.3 mmol/L(women),hypertension,and diabetes were significantly more common in patients after transplantation.The independent factors associated with PTMS were older age,preoperative obesity and preoperative diabetes.Conclusions PTMS is highly prevalent among transplant recipients,older age(＞ 50 years),preoperative obesity and preoperative diabetes are among the risk factors for PTMS.