Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, P 2131, DK-2100 Copenhagen, Denmark.
Clin J Am Soc Nephrol. 2010 Apr;5(4):709-16. doi: 10.2215/CJN.05360709. Epub 2010 Feb 18.
This study aimed to investigate the development of new-onset diabetes mellitus (NODM) in a prospective study of 97 nondiabetic uremic patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Included were 57 kidney recipients (Tx group, age 39 +/- 13 years) and 40 uremic patients remaining on the waiting list for kidney transplantation (uremic controls, age 47 +/- 11 years). All were examined at baseline before possible transplantation and after 12 months. The prevalence of diabetes, prediabetes, insulin sensitivity index (ISI), and insulin secretion index (Isecr) were estimated using an oral glucose tolerance test with measurements of plasma glucose and plasma insulin.
One year after transplantation NODM was present in 14% (8 of 57) compared with 5% (2 of 40) in the uremic control group (P = 0.01). ISI in the Tx group deteriorated from 6.8 +/- 3.9 before transplantation to 4.9 +/- 2.8 at 12 months after transplantation (P = 0.005), and a slight increase in Isecr from 37 +/- 19 to 46 +/- 22 (P = 0.02) was seen. No significant changes occurred in the uremic controls (ISI was 7.9 +/- 5 and 8.5 +/- 5, and Isecr was 31 +/- 17 and 28 +/- 15). Using multivariate ordinal logistic regression, pre-Tx ISI and age predicted NODM (odds ratios: 0.82, P = 0.01 and 1.06, P = 0.02, respectively).
One year after kidney transplantation, NODM was present in 14% of patients. This was mainly caused by an increase in insulin resistance and was observed despite improvement in insulin secretion.
本研究旨在对 97 例非糖尿病性尿毒症患者进行前瞻性研究，以调查新发糖尿病（NODM）的发生情况。
设计、地点、参与者和测量方法：包括 57 例肾脏移植受者（Tx 组，年龄 39 ± 13 岁）和 40 例等待肾脏移植的尿毒症患者（尿毒症对照组，年龄 47 ± 11 岁）。所有患者均在可能进行移植前和 12 个月后进行了基线检查。采用口服葡萄糖耐量试验，测量血糖和血浆胰岛素，估计糖尿病、糖尿病前期、胰岛素敏感指数（ISI）和胰岛素分泌指数（Isecr）的患病率。
移植后 1 年，NODM 发生率在 Tx 组为 14%（8/57），而尿毒症对照组为 5%（2/40）（P = 0.01）。Tx 组的 ISI 从移植前的 6.8 ± 3.9 恶化至移植后 12 个月的 4.9 ± 2.8（P = 0.005），而 Isecr 从 37 ± 19 略有增加至 46 ± 22（P = 0.02）。尿毒症对照组无明显变化（ISI 分别为 7.9 ± 5 和 8.5 ± 5，Isecr 分别为 31 ± 17 和 28 ± 15）。采用多变量有序逻辑回归分析，Tx 前 ISI 和年龄预测了 NODM（优势比：0.82，P = 0.01 和 1.06，P = 0.02）。
移植后 1 年，14%的患者出现 NODM。这主要是由于胰岛素抵抗增加引起的，尽管胰岛素分泌有所改善，但仍观察到这种情况。
