Gentil Miguel A, Luna Enrique, Rodriguez-Algarra Gabriel, Osuna Antonio, González-Molina Miguel, Mazuecos Auxiliadora, Cubero Juan J, Del Castillo Domingo
Department of Nephrology, Hospital Virgen del Rocío, Sevilla, Spain.
Nephrol Dial Transplant. 2002 May;17(5):887-91. doi: 10.1093/ndt/17.5.887.
Hepatitis C virus (HCV) infection has been associated with an increased incidence of diabetes mellitus, both in the general population and among transplant patients.
To test this hypothesis, we reviewed the records of 1614 patients who had undergone renal transplant at six Spanish centres between 1992 and 1998. We established the rate of onset of diabetes mellitus requiring >1 month of treatment with insulin (insulin-treated diabetes mellitus, I-TDM) among the 177 patients showing HCV antibody seropositivity at the time of transplant (HCV+ group). As controls, 177 HCV patients were selected who had received a kidney allograft immediately before or after the study patients at the same centre.
The HCV+ patients were well matched with controls in terms of characteristics (except a longer time on dialysis) and immunosuppressive treatment. After a mean follow-up of 44 months, 28 cases of I-TDM were diagnosed (9.6% in HCV+ and 6.2% HCV-, not significant (NS); odds ratio 1.6; 95% confidence interval 0.75-3.50). The onset of I-TDM was somewhat later in HCV+ patients (467 days vs. 292 days in HCV- patients, NS). Multivariate analysis identified the following prognostic factors for I-TDM onset: age and BMI at the time of transplant, and polycystic kidney disease as the underlying cause of chronic renal insufficiency. No correlation was found with HCV positivity or time on dialysis.
We were unable to confirm a greater incidence of post-renal transplant insulin-requiring diabetes in association with HCV infection. However, the observed tendency towards such an association suggests that the follow-up period would need to be extended.
在普通人群和移植患者中，丙型肝炎病毒（HCV）感染都与糖尿病发病率的增加有关。
为验证这一假设，我们回顾了1992年至1998年间在西班牙六个中心接受肾移植的1614例患者的记录。我们确定了在移植时HCV抗体血清学呈阳性的177例患者（HCV+组）中需要胰岛素治疗超过1个月的糖尿病发病率（胰岛素治疗的糖尿病，I-TDM）。作为对照，选择了177例HCV患者，他们在同一中心在研究患者之前或之后立即接受了同种异体肾移植。
HCV+患者在特征（除透析时间较长外）和免疫抑制治疗方面与对照组匹配良好。平均随访44个月后，诊断出28例I-TDM（HCV+组为9.6%，HCV-组为6.2%，无显著性差异（NS）；优势比为1.6；95%置信区间为0.75-3.50）。HCV+患者中I-TDM的发病时间稍晚（HCV+患者为467天，HCV-患者为292天，无显著性差异）。多变量分析确定了I-TDM发病的以下预后因素：移植时的年龄和体重指数，以及多囊肾病作为慢性肾功能不全的潜在病因。未发现与HCV阳性或透析时间相关。
我们无法证实肾移植后与HCV感染相关的胰岛素依赖型糖尿病发病率更高。然而，观察到的这种关联趋势表明需要延长随访期。
