心脏移植患者术后空腹血糖变化规律及影响因素分析

目的探讨心脏移植术后患者空腹血糖的变化规律、移植后糖尿病（PTDM）的发病率及其相关危险因素，为防治PTDM提供临床依据。方法对术前病史资料详实、术后存活时间〉3个月的66例心脏移植患者进行回顾性研究。根据术前空腹血糖水平，将患者分为3组：移植前糖尿病（Pre—DM）组12例、空腹血糖受损（IFG）组11例、空腹血糖正常（NFG）组43例，观察3组术后空腹血糖变化规律。对54例术前非糖尿病患者，根据空腹血糖分析术后PTDM发生及转归，并对移植后新生糖尿病可能的危险因素进行单因素和多因素回归分析。结果心脏移植术后Pre—DM组、IFG组、NFG组术前、术后7d、术后6个月、术后1年空腹血糖分别为（8．5±1．9）、（10．3±2．7）、（7．6±2．4）、（7．0±1．7）mmol／L；（6．7±1．7）、（10．2±3．8）、（6．3±1．2）、（6．1±1．0）mmol／L；（4．6±0．6）、（8．2±3．9）、（5．9±2．0）、（5．7±1．1）mmol／L，3组术后7d空腹血糖水平均高于术前，差异均有统计学意义（均P〈0．05）。54例术前非糖尿病患者中20例（37．0％）发生PTDM，其中12例（60．0％）患者PTDM持续存在，8例（40．0％）在随访中转为NFG或IFG。单因素分析提示，体重指数、术前三酰甘油水平及环孢素A血药浓度与PTDM的发生有关，差异有统计学意义（P〈0．05）。多因素Logistic回归分析显示，术前三酰甘油水平（比值比为6．373，P=0．016）和环孢素A血药浓度偏高（比值比为6．352，P=0．016）为发生PTDM的危险因素。结论PTDM并非持续存在，在病程中有可能转为IFG或NFG。术前三酰甘油水平和环孢素A血药浓度偏高可增加PTDM患病风险。

Analysis on the changing trend of fasting plasma glucose and risk factors for post-transplant diabetes mellitus after heart transplantation

Objective To investigate the fluctuation of fasting plasma glucose （FPG）, incidence and presence of risk factors for post-transplant diabetes mellitus （PTDM） after heart transplantation. Methods The clinical data of 66 patients undergoing heart transplantation and surviving for more than 3 months were retrospectively analyzed. According to preoperative FPG levels, patients were divided into three groups： preoperative diabetes mellitus（Pre-DM, 12 cases）, impaired fasting glucose （IFG, 11 cases） and normal fasting glucose（ NFG, 43 cases）. The changing trend of FPG level was observed. For 54 non-diabetes patients before transplantation, the prevalence and different outcomes of PTDM according to FPG after transplantation were analyzed. Univariate analy- sis and logistic regression for multivariate analysis were performed to identify the risk factors associated with devel- opment of PTDM. Results FPG in pre-transplant, 1 week post-transplant, 6-month post-transplant, 1-year post- transplant in three groups were respectively ： Pre-DM group ： （ 8.5 ± 1.9 ）, （ 10.3 ± 2.7 ）, （ 7.6 ± 2.4 ）, （7.0 ± 1.7 ） mmol/L ; IFG group ： （6.7 ± 1.7 ）, （ 10.2 ± 3.8 ）, （ 6.3 ± 1.2 ）, （ 6.1 ± 1.0 ） mmol/L ; NFG group ： （4.6 ± 0.6）, （ 8.2 ± 3.9 ）, （ 5.9 ± 2.0 ）, （ 5.7 ± 1.1 ） mmol/L ], patients＇ FPG within 1-week post-transplant were higher than those pre-transplant, there was statistically significant difference among the three groups（P 〈0. 05）. Of the 54 patients, 20 cases developed PTDM, including 12 cases （ 60.0% ） with persistent PTDM and 8 cases （40.0%） turning into NFG or IFG. Univariate analysis showed that body mass index, preoperative triglyceride levels and eyclosporin A plasma concentration were risk factors; multivariate logistic regression analysis identified the following predictive factors for the development of PTDM ： preoperative triglyeeride levels （ OR = 6. 373, P =0. 016） and cyclosporin A plasma concentration （ OR = 6. 352, P = 0. 016）. Conclusions VFDM will not be per- manent and may recover to NFG and IFG in the course of the disease. Preoperative triglyceride levels and cyclosporin A plasma concentration are risk factors for the development of PTDM during follow-ups.