Hjelmesaeth Jøran, Asberg Anders, Müller Fredrik, Hartmann Anders, Jenssen Trond
Department of Medicine, Rikshospitalet University Hospital, Oslo, Norway.
Curr Diabetes Rev. 2005 Feb;1(1):1-10. doi: 10.2174/1573399052952604.
Restoration of renal function may ameliorate uremia induced insulin resistance. Therefore it seems a paradox that new-onset posttransplantation diabetes mellitus (PTDM) is a frequently observed complication after renal transplantation. The incidence varies between 2 and 50% depending on the population under study, criteria for the diagnosis of diabetes and the time of follow up. This review addresses recent findings on transplant specific risk factors and pathogenesis of PTDM after solid organ transplantation, and we focus on the following issues: 1. The relative impact of insulin resistance and insulinopenia in the pathogenesis of PTDM. 2. The role of immunosuppressive drugs with special emphasis on calcineurin inhibitors (cyclosporine A, tacrolimus) and steroids. 3. The possible roles of cytomegalovirus and hepatitis C infections.
New-onset PTDM is characterized by a variety of clinical manifestations, ranging from predominantly insulin resistance which can be handled with lifestyle intervention, to beta-cell failure requiring insulin treatment. The etiology is multi-factorial, but diabetogenic immunosuppressive drugs are of major importance. Future studies should therefore address the effects of different immunosuppressive regimens on the incidence of PTDM. In addition, the impact of cytomegalovirus infection and hepatitis C on PTDM needs further evaluation.
肾功能的恢复可能会改善尿毒症诱导的胰岛素抵抗。因此，肾移植后新发糖尿病（PTDM）是肾移植后常见的并发症，这似乎是一个矛盾的现象。其发病率在2%至50%之间，具体取决于所研究的人群、糖尿病的诊断标准以及随访时间。本综述阐述了实体器官移植后PTDM的移植特异性危险因素和发病机制的最新研究结果，我们重点关注以下问题：1. 胰岛素抵抗和胰岛素缺乏在PTDM发病机制中的相对影响。2. 免疫抑制药物的作用，特别强调钙调神经磷酸酶抑制剂（环孢素A、他克莫司）和类固醇。3. 巨细胞病毒和丙型肝炎感染的可能作用。
新发PTDM具有多种临床表现，从主要可通过生活方式干预处理的胰岛素抵抗，到需要胰岛素治疗的β细胞功能衰竭。其病因是多因素的，但具有致糖尿病作用的免疫抑制药物至关重要。因此，未来的研究应探讨不同免疫抑制方案对PTDM发病率的影响。此外，巨细胞病毒感染和丙型肝炎对PTDM的影响需要进一步评估。
