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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

陈荣鑫 赖兴强 张磊 方佳丽 徐海林 刘路浩 张鹏 吴佳林 曹米布 马俊杰 陈正

陈荣鑫, 赖兴强, 张磊, 等. 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[J]. 器官移植, 2021, 12(3): 329-335. doi: 10.3969/j.issn.1674-7445.2021.03.012
引用本文: 陈荣鑫, 赖兴强, 张磊, 等. 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[J]. 器官移植, 2021, 12(3): 329-335. doi: 10.3969/j.issn.1674-7445.2021.03.012
Chen Rongxin, Lai Xingqiang, Zhang Lei, et al. Analysis of risk factors and establishment of prediction model for post transplantation diabetes mellitus in renal transplant recipients[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 329-335. doi: 10.3969/j.issn.1674-7445.2021.03.012
Citation: Chen Rongxin, Lai Xingqiang, Zhang Lei, et al. Analysis of risk factors and establishment of prediction model for post transplantation diabetes mellitus in renal transplant recipients[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 329-335. doi: 10.3969/j.issn.1674-7445.2021.03.012

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

doi: 10.3969/j.issn.1674-7445.2021.03.012
基金项目: 

国家自然科学基金 81601393

广州市临床重大科技项目 2019ZD12

详细信息
    作者简介:

    陈荣鑫,男,1984年生,硕士,主治医师,研究方向为器官移植重症监护,Email: rxchen09@163.com

    通讯作者:

    陈正,男,1974年生,博士,主任医师,研究方向为器官移植,Email: docchenzheng@163.com

  • 中图分类号: R617, R587

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

More Information
  • 摘要:   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。

     

  • 图  1  联合预测因子对于肾移植受者发生PTDM的预测价值

    Figure  1.  The predictive value of combined predictors for the occurrence of PTDM in renal transplant recipients

    表  1  肾移植受者发生PTDM危险因素的单因素分析

    Table  1.   Univariate analysis of risk factors of the occurrence of PTDM in renal transplant recipients

    变量 单因素分析
    OR 95%CI P
    年龄 1.041 1.020~1.061 < 0.001
    性别 1.231 0.746~2.032 0.416
    糖尿病家族史 9.169 5.540~15.174 < 0.001
    BMI 1.153 1.083~1.229 < 0.001
    原发病 0.833 0.616~1.126 0.234
    有否透析 0.954 0.641~1.420 0.816
    供肾类型 0.713 0.252~2.017 0.524
    CNI类型 2.455 1.242~4.852 0.010
    抗增殖类药物类型 0.666 0.406~1.094 0.108
    术前空腹血糖 0.780 0.067~1.003 0.053
    术前餐后1 h血糖 0.904 0.810~1.009 0.073
    术前餐后2 h血糖 1.186 1.090~1.290 < 0.001
    术前空腹C肽 0.973 0.923~1.025 0.305
    术前餐后1 h C肽 0.970 0.935~1.006 0.099
    术前餐后2 h C肽 0.979 0.951~1.007 0.143
    术前糖化血红蛋白 2.198 1.596~3.027 < 0.001
    术前白蛋白 1.032 0.993~1.074 0.110
    术前甘油三酯 0.997 0.945~1.052 0.917
    术前总胆固醇 1.213 0.999~1.473 0.051
    下载: 导出CSV

    表  2  肾移植受者发生PTDM的危险因素多因素分析

    Table  2.   Multivariate analysis of risk factors of the occurrence of PTDM in renal transplant recipients

    变量 回归系数 标准误 Wald χ2 OR 95%CI P
    糖尿病家族史 2.199 0.269 66.626 9.016 5.317~15.288 < 0.001
    BMI 0.109 0.037 8.906 1.115 1.038~1.198 0.003
    术前餐后2 h血糖 0.151 0.051 8.636 1.163 1.051~1.285 0.003
    术前糖化血红蛋白 0.508 0.185 7.564 1.661 1.157~2.385 0.006
    常数项 -9.123 1.209 56.929 0.000 - 0.000
      注: ① - 为无数据。
    下载: 导出CSV
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  • 收稿日期:  2021-01-25
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