肾移植后1年存活者空腹血糖变化及预后

摘要

背景：肾移植后糖尿病是移植脏器的重要代谢并发症，严重影响患者生活质量与长期生存率，是移植肾失功能、心血管疾病的危险因素。目的：观察肾移植后存活1年以上患者空腹血糖变化规律以及对预后的影响。方法：选取2003年1月至2013年1月接受过肾移植后来仙桃市第一人民医院就诊的患者42例，其中移植前糖尿病患者7例、空腹血糖受损组11例和空腹血糖正常患者24例，观察各组患者移植后1，7，14 d以及1，3，6，12个月空腹血糖变化，并比较各组移植后生存情况，采用Cox比例风险模型分析影响肾移植患者生存的因素。结果与结论：糖尿病组患者移植前及移植后各时间段空腹血糖明显高于空腹血糖受损和空腹血糖正常组患者(P <0.05)，糖尿病、空腹血糖受损和空腹血糖正常组患者空腹血糖在移植后第1天均升高(P <0.05)，各组空腹血糖在移植后3个月趋于平稳；空腹血糖正常组生存率明显高于糖尿病组和空腹血糖受损组(P<0.05)。Cox 比例风险模型分析结果显示，移植前空腹血糖、年龄、移植后肿瘤和感染是肾移植患者死亡的独立危险因素，其中移植后发生肿瘤的死亡危险比最高，为2.376。结果证实，移植前糖尿病对肾移植后存活1年以上患者生存率有一定的影响，移植后糖尿病对患者生存率的无明显影响。%BACKGROUND:Diabetes mel itus after kidney transplantation is an important metabolic complication of the transplanted organ, and seriously affects the quality of life and long-term survival rate of patients, which is a risk factor for renal al ograft dysfunction and cardiovascular disease. OBJECTIVE:To investigate the changes in fasting blood glucose and prognosis of patients who had survived more than 1 year after renal transplantation. METHODS:Total y 42 patients undergoing renal transplantation admitted at Xiantao First People’s Hospital from January 2003 to January 2013, including 7 cases of preoperative diabetes, 11 cases of impaired fasting glucose and 24 cases of normal fasting blood glucose. Fasting blood glucose levels were detected at 1, 7, 14 days and 1, 3, 6, 12 months after renal transplantation, and the survival conditions were also compared among different groups. Cox proportional hazard model was used to analyze influential factors of survival in patients undergoing renal transplantation. RESULTS AND CONCLUSION:The fasting blood glucose levels in the diabetes mel itus group were significantly higher than those in the impaired fasting glucose group and normal fasting blood glucose group before and after renal transplantation (P<0.05). The fasting blood glucose levels were increased in al the groups at 1 day after transplantation (P<0.05), and stabilized at 3 months after transplantation. The survival rate was significantly higher in the normal fasting blood glucose group than in the diabetes mel itus and impaired fasting glucose groups after renal transplantation (P<0.05). Cox proportional hazard model analysis showed that preoperative fasting blood glucose, age, postoperative tumor and infection were the independent risk factors for death in patients undergoing renal transplantation, among which, postoperative tumor led to the highest death risk ratio that was 2.376. Taken together, preoperative diabetes mel itus has some impacts on renal recipients who survive more than 1 year fol owing transplantation, but postoperative diabetes mel itus had no influence on the survival rate of the patients.