肾移植受者发生移植后糖尿病的危险因素分析及预测模型的构建

目的  分析肾移植受者发生移植后糖尿病（PTDM）的危险因素，建立PTDM预测模型并评价其预测价值。方法  回顾性分析915例肾移植受者的临床资料。根据有否发生PTDM，分为PTDM组（78例）和非PTDM组（837例）。收集受者的主要指标，对肾移植受者发生PTDM的危险因素进行单因素和多因素分析; 建立PTDM预测模型并评价其预测价值。结果  糖尿病家族史、体质量指数（BMI）、术前餐后2 h血糖、术前糖化血红蛋白是肾移植受者发生PTDM的独立危险因素。PTDM预测模型为logit（P）=2.199×糖尿病家族史（有=1，无=0）+0.109×BMI+0.151×餐后2 h血糖（mmol/L）+0.508×糖化血红蛋白（%）-9.123。受试者工作特征（ROC）曲线结果显示，联合4种预测因子预测肾移植受者发生PTDM的曲线下面积（AUC）为0.830[95%可信区间（CI）0.786~0.873]，界值为0.0608，灵敏度为0.821，特异度为0.700，约登指数为0.521（P < 0.05）。结论  糖尿病家族史、BMI、术前餐后2 h血糖、术前糖化血红蛋白是肾移植受者发生PTDM的独立危险因素。联合4种预测因子的PTDM预测模型具有较好的预测价值。

Analysis of risk factors and establishment of prediction model for post transplantation diabetes mellitus in renal transplant recipients

Objective To analyze the risk factors for the occurrence of post transplantation diabetes mellitus (PTDM) in renal transplant recipients, establish a prediction model for PTDM and evaluate its prediction value. Methods Clinical data of 915 renal transplant recipients were retrospectively analyzed. According to the occurrence of PTDM, all recipients were divided into the PTDM group (n=78) and non-PTDM group (n=837). The main indexes of recipients were collected. The risk factors for the occurrence of PTDM in renal transplant recipients were analyzed by univariate and multivariate analysis. The prediction model for PTDM was established and its prediction value was evaluated. Results Family history of diabetes mellitus, body mass index (BMI), preoperative 2 h postprandial blood glucose and preoperative glycosylated hemoglobin were the independent risk factors for the occurrence of PTDM in renal transplant recipients. The prediction model for PTDM was logit (P)=2.199×family history of diabetes (yes=1, no=0)+0.109×BMI+0.151×2 h postprandial blood glucose (mmol/L)+0.508×glycosylated hemoglobin (%)-9.123. The results of receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of these 4 predictors combined for predicting PTDM in renal transplant recipients was 0.830 [95% confidence interval (CI) 0.786-0.873], the cut-off value was 0.0608, the sensitivity was 0.821, the specificity was 0.700, and the Youden index was 0.521 (P < 0.05). Conclusions Family history of diabetes mellitus, BMI, preoperative 2 h postprandial blood glucose and preoperative glycosylated hemoglobin are the independent risk factors for the occurrence of PTDM in renal transplant recipients. The prediction model for PTDM combined with4 predictors yield relatively high prediction value for PTDM.