脂联素与肾移植后新发糖尿病的风险
Adiponectin and risk of new-onset diabetes mellitus after kidney transplantation.
作者信息
Bayés Beatriz, Lauzurica Ricardo, Granada Maria Luisa, Serra Assumpta, Bonet Josep, Fontseré Nestor, Salinas Isabel, Romero Ramón
机构信息
Department of Nephrology, Hospital Universitari "Germans Trias i Pujol", Autonomous University of Barcelona, Spain.
出版信息
Transplantation. 2004 Jul 15;78(1):26-30. doi: 10.1097/01.tp.0000132561.48217.b1.
BACKGROUND
New-onset diabetes mellitus after transplantation (NODAT) is a severe complication of kidney transplantation (KTx) with negative effects upon patient and graft survival. Several risk factors for NODAT have been described; however, the search for an early predictive marker is ongoing. It has recently been demonstrated that high concentrations of adiponectin (APN), which is an adipocyte-derived peptide with antiinflammatory and insulin-sensitizing properties, protect against future development of type 2 diabetes in healthy individuals. The purpose of this report was to study pretransplant insulin resistance and analyze pretransplant serum leptin and APN levels as independent risk factors for the development of NODAT.
METHODS
A total of 68 KTx patients were studied [mean age, 48 +/- 11 years; 70% males; body mass index (BMI), 25 +/- 3 kg/m]; 31 KTx patients with NODAT and 37 KTx patients without NODAT (non-NODAT) with similar age, sex, BMI, immunosuppression, and posttransplant time were studied. All patients received prednisone and calcineurin inhibitors (75% tacrolimus and 25% cyclosporine A), and 76% of patients received mycophenolate mofetil. Family history of diabetes mellitus was recorded. Pretransplant homeostasis model assessment for insulin resistance (HOMA-IR) index was calculated from fasting plasma glucose and insulin. Pretransplant serum leptin and APN levels were determined by radioimmunoassay.
RESULTS
NODAT patients showed higher pretransplant plasma insulin concentrations [NODAT, 13.4 (11-22.7) microIU/mL; non-NODAT, 10.05 (7.45-18.4) microIU/mL; P=0.049], HOMA-IR index [NODAT, 4.18 (2.49-5.75); non-NODAT, 2.63 (1.52-4.68); P=0.043], and lower pretransplant serum APN concentration [NODAT, 8.78 (7.2-11.38) microg/mL; non-NODAT, 11.4 (8.56-15.27) microg/mL, P=0.012]. Inverse correlations between APN and BMI (r=-0.33; P=0.014) and APN and HOMA-IR index (r=-0.39; P=0.002) and between APN and NODAT (r=-0.31; P=0.011) were observed. Multiple logistic regression analysis showed the patients with lower pretransplant APN concentrations to be those at greater risk of developing NODAT [Odds Ratio=0.832 (0.71-0.96); P=0.01].
CONCLUSION
Pretransplant serum APN concentration is an independent predictive factor for NODAT development in kidney-transplanted patients.
背景
移植后新发糖尿病（NODAT）是肾移植（KTx）的一种严重并发症，对患者和移植物存活均有负面影响。已描述了多种NODAT的危险因素；然而，对早期预测标志物的探索仍在进行中。最近有研究表明，脂联素（APN）是一种由脂肪细胞分泌的具有抗炎和胰岛素增敏特性的肽，高浓度的APN可预防健康个体发生2型糖尿病。本报告的目的是研究移植前胰岛素抵抗，并分析移植前血清瘦素和APN水平作为NODAT发生的独立危险因素。
方法
共研究了68例KTx患者[平均年龄48±11岁；70%为男性；体重指数（BMI）25±3kg/m²]；研究了31例发生NODAT的KTx患者和37例未发生NODAT（非NODAT）的KTx患者，这些患者年龄、性别、BMI、免疫抑制及移植后时间相似。所有患者均接受泼尼松和钙调神经磷酸酶抑制剂（75%为他克莫司，25%为环孢素A），76%的患者接受霉酚酸酯。记录糖尿病家族史。根据空腹血糖和胰岛素计算移植前胰岛素抵抗的稳态模型评估（HOMA-IR）指数。移植前血清瘦素和APN水平通过放射免疫分析测定。
结果
NODAT患者移植前血浆胰岛素浓度更高[NODAT组为13.4（11 - 22.7）μIU/mL；非NODAT组为10.05（7.45 - 18.4）μIU/mL；P = 0.049]，HOMA-IR指数更高[NODAT组为4.18（2.49 - 5.75）；非NODAT组为2.63（1.52 - 4.68）；P = 0.043]，而移植前血清APN浓度更低[NODAT组为8.78（7.2 - 11.38）μg/mL；非NODAT组为11.4（8.56 - 15.27）μg/mL，P = 0.012]。观察到APN与BMI（r = -0.33；P = 0.014）、APN与HOMA-IR指数（r = -0.39；P = 0.002）以及APN与NODAT（r = -0.31；P = 0.011）之间呈负相关。多因素logistic回归分析显示，移植前APN浓度较低的患者发生NODAT的风险更高[比值比 = 0.832（0.71 - 0.96）；P = 0.01]。
结论
移植前血清APN浓度是肾移植患者发生NODAT的独立预测因素。
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