心脏移植术后新生糖尿病的危险因素分析

目的 探讨原位心脏移植术后新生糖尿病的发病率、发生的独立危险因素及其对患者长期存活的影响.方法 对术前病史资料详实、无糖尿病、术后存活时间大于6个月的92例原位心脏移植患者进行回顾性研究.患者平均随访31个月.随访期间发生移植后新生糖尿病者(PTDM组)共19例(19/92,20.7%),未发生新生糖尿病者(NPTDM组)73例.记录与移植后新生糖尿病相关的因素,并对可能的危险因素进行单因素分析和多因素回归分析.记录原位心脏移植术后新生糖尿病的发病率.绘制患者的Kaptan-Meier生存曲线.结果 移植后患者整体的空腹血糖水平较移植前明显升高[移植后为(5.52±1.07)mmol/L,移植前为(4.95±0.64)mmol/L,P%0.01].多因素Logistic回归分析显示,移植后新生糖尿病发生的独立危险预测因素是高龄(OR=1.09,P<0.05)、体重指数(OR=1.45,P<0.01)、糖尿病家族史(OR=7.97,P<0.05)和术前空腹血糖(OR=5.83,P<0.01).92例患者术后1、3和5年存活率分别为96.29%、88.80%和80.62%,PTDM组术后1、3和5年存活率分别为87.50%、72.92%和72.92%,NPTDM组术后1、3和5年存活率分别为96.95%、93.44%和81.95%.分层次Log-rank检验显示,PTDM组和NPTDM组的两条生存曲线无明显差异(P>0.05).结论 移植后新生糖尿病的独立危险因素包括年龄、糖尿病家族史、体重指数和术前空腹血糖状态.

Study on risk factors for new onset diabetes mellitus post orthotopic heart transplant (PTDM) and the relationship between PTDM and long-term survival

Objective To investigate the incidence and presence of risk factors for new onset diabetes mellitus post orthotopic heart transplant (PTDM), and the relationship between PTDM and long-term survival after heart transplantation (HT). Methods Ninety-two non-DM patients were studied, who underwent orthotopic heart transplantation from September 2000 to December 2006 and had follow-up regularly. According to the diagnostic criteria of PTDM, they were divided into two groups. All variables that could be related to the development of PTDM during follow-up were analyzed, and the risk factors for PTDM were determined. Student t-test, Wilcoxon rank sum test and X~2 test were used for univariate statistical analysis and logistic regression for multivariate analysis. The incidence of PTDM was recorded. Kaplan-Meier method and log rank test were used for survival analysis. Results Of the 92 patients, 19 developed DM (20.7%). Student t-test revealed that mean fasting blood glucose level after transplantation was higher than pre-transplant (5.52±1.07 vs 4.95±0.64, P<0.01). The multivariate analysis identified the following as predictive factors for the development of PTDM: age (OR=1.09, P<0.05), body mass index (BMI) (OR=1.45,P<0.01), family history of DM (OR=7.97,P<0.05), fasting blood glucose level before operation (OR =5.83,P<0.01). Overall patient survival rate at one, three and five-yr post transplant was 96.29%, 88.80%, and 80.62% respectively. The survival rate in PTDM patients at one, three and five-yr post transplant was 87.50%, 72.92%, 72.92%, respectively. The survival rate in NPTDM patients at one, three and five-yr post transplant was 96.95%, 93.44%, 81.95%, respectively,which revealed that oatients with PTDM had the worse outcome (P>0.05). Conclusion Age,Pre-operative overweight especially body mass index, family history of DM, and fasting blood glucose level were significant and independent risk factors for the development of PTDM during follow-up.