Department of Cardiology, Medical University of Vienna, Vienna, Austria.
Transplantation. 2010 Mar 15;89(5):612-9. doi: 10.1097/TP.0b013e3181c6ffa4.
The efficacy of tight glycemic control for the prevention of death and renal failure in the general diabetic population is well established. However, in diabetic renal-allograft recipients, the effect of different treatment strategies on outcomes is undetermined.
We conducted a cohort study of 798 diabetic, renal-allograft recipients transplanted at the Medical University of Vienna between 1990 and 2004. We studied the influence of glucose parameters and diabetes treatment on mortality and graft loss. Marginal-structural models and multivariable Cox regression analysis were used to control for confounding.
Maximal glucose levels but not HbA1c were independently associated with mortality. Being in the highest quartile of maximal glucose increased the adjusted risk of death by a factor of 2.2 (P value for trend 0.009). Furthermore, in patients receiving insulin, the risk of death was increased 1.7-fold (95% confidence interval 0.9-3.1) compared with diet and 2.0-fold (95% confidence interval 1.1-3.7) compared with oral medication. Maximal glucose, HbA1c, or diabetes treatment did not influence death-censored functional graft survival.
In conclusion, maximal glucose levels and insulin treatment were independently associated with higher rates of mortality in our cohort of diabetic, renal-allograft recipients. However, graft survival was unaffected.
严格血糖控制对预防普通糖尿病患者的死亡和肾衰竭的疗效已得到充分证实。然而，在糖尿病肾移植受者中，不同治疗策略对结局的影响尚不确定。
我们对维也纳医科大学 1990 年至 2004 年间移植的 798 例糖尿病肾移植受者进行了队列研究。我们研究了葡萄糖参数和糖尿病治疗对死亡率和移植物丢失的影响。边缘结构模型和多变量 Cox 回归分析用于控制混杂因素。
最大血糖水平而非 HbA1c 与死亡率独立相关。最大血糖处于最高四分位时，调整后的死亡风险增加了 2.2 倍（趋势 P 值<0.009）。此外，与饮食相比，接受胰岛素治疗的患者死亡风险增加 1.7 倍（95%置信区间 0.9-3.1），与口服药物相比增加 2.0 倍（95%置信区间 1.1-3.7）。最大血糖、HbA1c 或糖尿病治疗并未影响死亡删失的功能移植物存活。
总之，在我们的糖尿病肾移植受者队列中，最大血糖水平和胰岛素治疗与更高的死亡率独立相关。然而，移植物存活率未受影响。
