他克莫司诱发移植后新发糖尿病高于环孢素A的机制研究进展

目的:综述近年来国内外学者对环孢素A和他克莫司诱发移植后新发糖尿病的机制研究,为临床合理用药提供依据。方法:检索国内外相关文献,进行整理和综合分析。结果:NODAT(new-onset diabetes after transplantation)即移植后新发糖尿病,也称PTDM(post-transplant diabetes mellitus),是器官移植患者常见、严重的并发症。NODAT发病的危险因素包括年龄、性别、高剂量类固醇、体重指数、家族史和免疫抑制剂,其中免疫抑制剂的使用是发病的高危因素。环孢素A和他克莫司是两种主要的免疫抑制剂,应用免疫抑制剂可以减少移植后急性排斥反应的发生率,提高患者的生存率,但使用免疫抑制剂会诱发NODAT,他克莫司导致NODAT发生率高于环孢素A,具体机制目前尚无定论。结论:临床医生可以根据他克莫司导致NODAT发生率高于环孢素A的机制,制定合理的给药方案。

Progress in different diabetogenic mechanisms of tacrolimus and cyclosporine A on NODAT

OBJECTIVE To review studies on different diabetogenic mechanisms of tacrolimus and cyclosporine A on new-onset diabetes after transplantation (NODAT), and provide evidence for rational use in clinical practice. METHODS A comprehensive study was conducted by retrieving related literatures. RESULTS NODAT was also called PTDM (post-transplant diabetes mellitus) in some reports. It was a serious metabolic complication occurred frequently in transplant recipients. High risk factors of NODAT included recipient age, male gender, high dose steroid, body mass index, family history of diabetes and immunosuppressant. Among them, the use of immunosuppressant was the important risk factor for NODAT. Cyclosporin A and tacrolimus were two main immunosuppressive drugs widely used to prevent organ rejection after transplantation. The application of immunosuppressant in transplant patients decreased the acute rejection rate, and improved the long-time survival rate. There was a higher incidence of NODAT in the recipients who received tacrolimus than in those who received cyclosporin A, but the underlying mechanism had not been elucidated. CONCLUSION The physicians should be aware of their different diabetogenic mechanisms and develop a rational dosing regimen.