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他克莫司与肾移植术后糖尿病相关性的单中心研究

王梓宇, 董晨, 王洪阳, 等. 他克莫司与肾移植术后糖尿病相关性的单中心研究[J]. 器官移植, 2022, 13(6): 776-782. doi: 10.3969/j.issn.1674-7445.2022.06.013
引用本文: 王梓宇, 董晨, 王洪阳, 等. 他克莫司与肾移植术后糖尿病相关性的单中心研究[J]. 器官移植, 2022, 13(6): 776-782. doi: 10.3969/j.issn.1674-7445.2022.06.013
Wang Ziyu, Dong Chen, Wang Hongyang, et al. Correlation between tacrolimus and diabetes mellitus after kidney transplantation: a single center study[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 776-782. doi: 10.3969/j.issn.1674-7445.2022.06.013
Citation: Wang Ziyu, Dong Chen, Wang Hongyang, et al. Correlation between tacrolimus and diabetes mellitus after kidney transplantation: a single center study[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 776-782. doi: 10.3969/j.issn.1674-7445.2022.06.013

他克莫司与肾移植术后糖尿病相关性的单中心研究

doi: 10.3969/j.issn.1674-7445.2022.06.013
基金项目: 

山东省自然科学基金青年项目 ZR2020QH237

详细信息
    作者简介:
    通讯作者:

    董震,硕士,主任医师,研究方向为肾移植,Email:dong266000@163.com

  • 中图分类号: R617, R587.1

Correlation between tacrolimus and diabetes mellitus after kidney transplantation: a single center study

More Information
  • 摘要:   目的  探讨移植后糖尿病(PTDM)的主要危险因素,分析他克莫司与肾移植PTDM发生的相关性。  方法  收集123例肾移植受者的临床资料,分为PTDM组(19例)和非PTDM组(104例)。分析两组受者的临床资料,采用二元logistic回归分析PTDM的危险因素。将24只小鼠分为对照组(生理盐水),他克莫司低剂量组(0.1 mg/kg)、中剂量组(0.75 mg/kg)和高剂量组(1.5 mg/kg),每组各6只,分别每日注射2次。分析他克莫司对小鼠血糖代谢的影响。  结果  肾移植术后1年内PTDM发生率为15.4%(19/123)。受者年龄≥48岁、移植术后3个月他克莫司谷浓度≥9 ng/mL是肾移植术后发生PTDM的危险因素(均为P < 0.05)。低剂量组、中剂量组和高剂量组小鼠给药后的空腹血糖水平低于给药前(均为P < 0.05),但不具有剂量依赖性(P=0.750)。低剂量组、中剂量组和高剂量组小鼠给药后餐后血糖水平高于给药前(均为P < 0.05),且呈现他克莫司剂量依赖性(P=0.012)。  结论  他克莫司与肾移植术后PTDM发生密切相关,受者年龄≥48岁、移植术后3个月他克莫司谷浓度≥9 ng/mL是PTDM发生的独立危险因素。他克莫司以剂量依赖性的方式影响小鼠餐后血糖水平。

     

  • 图  1  他克莫司对小鼠体质量和血糖代谢的影响

    注:与给药前比较,aP < 0.05。

    Figure  1.  Effects of tacrolimus on body mass and blood glucose metabolism in mice

    表  1  两组受者一般资料比较

    Table  1.   Comparison of general data of recipients between the two groups

    变量 PTDM组(n=19) 非PTDM组(n=104) 统计值 P
    年龄(x±s,岁) 48±8 40±11 3.17 0.004
    性别(男性)[n(%)] 16(84) 72(69) 1.77 0.162
    BMI(x±s,kg/m2 22±4 22±3 0.10 0.730
    糖尿病家族史[n(%)] 1(5) 3(3) - 0.494
    丙型病毒性肝炎史[n(%)] 0 1(1) - 1.000
    透析类型[n(%)] - 0.901
      血液透析 16(84) 79(76)
      腹膜透析 2(11) 17(16)
      未透析 1(5) 8(8)
    术前糖化白蛋白(x±s,%) 14.4±3.3 14.1±2.1 0.35 0.889
    术前低密度脂蛋白胆固醇(x±s,mmol/L) 2.3±0.8 2.5±0.8 -1.37 0.376
    术前甘油三酯[MP25P75),mmol/L] 1.40(1.00,1.67) 1.33(1.00,1.50) 0.42 0.803
    注:①-为无数据。
    下载: 导出CSV

    表  2  肾移植术后发生PTDM的危险因素分析

    Table  2.   Analysis of the risk factors for PTDM after kidney transplantation

    变量 PTDM组(n=19) 非PTDM组(n=104) OR P
    年龄(x±s,岁) 48±8 40±11 1.077 0.004
    诱导药物[n(%)] 1.201 0.726
      抗胸腺细胞球蛋白 7(37) 34(33)
      巴利昔单抗 12(63) 70(67)
    感染[n(%)] 8(42) 48(46) 0.848 0.744
    排斥反应[n(%)] 0 3(2.9) < 0.001 1.000
    糖皮质激素累积剂量(x±s,g) 1.9±0.1 1.9±0.1 1.000 1.000
    他克莫司谷浓度
      首次[MP25P75),ng/mL] 5.1(4.0,11.9) 9.7(6.2,12.8) 0.916 0.181
      术后1个月(x±s,ng/mL) 9.2±3.3 10.0±2.9 0.910 0.650
      术后3个月(x±s,ng/mL) 9.0±1.5 7.1±1.5 2.467 < 0.001
      术后6个月(x±s,ng/mL) 7.2±1.6 6.7±1.5 1.167 0.249
      术后12个月(x±s,ng/mL) 6.4±1.5 6.2±1.3 1.026 0.869
    术前BMI(x±s,kg/m2 22±4 22±3 1.006 0.917
    术前糖化白蛋白(x±s,%) 14.4±3.3 14.1±2.1 1.060 0.894
    术前低密度脂蛋白胆固醇(x±s,mmol/L) 2.3±0.8 2.5±0.8 0.611 0.979
    术前甘油三酯[MP25P75),mmol/L] 1.40(1.00,1.76) 1.33(1.00,1.50) 1.143 0.308
    注:①OR为比值比。
    下载: 导出CSV
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  • 收稿日期:  2022-06-16
  • 网络出版日期:  2022-11-14
  • 刊出日期:  2022-11-15

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