成人心脏移植受者新发糖尿病的危险因素。

Risk factors for development of new-onset diabetes mellitus in adult heart transplant recipients.

机构信息

Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

出版信息

Transplantation. 2010 Jun 27;89(12):1526-32. doi: 10.1097/TP.0b013e3181dd6bd9.

DOI:10.1097/TP.0b013e3181dd6bd9

PMID:20431437

Abstract

BACKGROUND

The objectives of this study are to examine the incidence of new-onset diabetes mellitus (NODM) and to identify its risk factors in adult heart recipients using the Organ Procurement and Transplant Network/United Network of Organ Sharing database.

METHODS

Between July 2004 and December 2007, 4972 adults (aged 18 years or older) received their first heart transplant alone, and had at least one follow-up report of posttransplant diabetic status. Among these, 3763 recipients were identified as not having diabetes mellitus pretransplant. Risk factors for NODM were examined using multivariate Cox regression analysis using the time to NODM diagnosis as a time-varying endpoint.

RESULTS

NODM was reported in 1075 (28.6%) of the 3763 recipients without pretransplant diabetes (median follow-up time, 713 days). Independent risk factors for development of NODM included older age (hazard ratio=1.20 for age >or=50 years vs. <50, P=0. 01), non-white race (0.70 for white vs. non-white, P<0.0001), higher body mass index (BMI) (1.55 for BMI >or=25 vs. <25, P<0.0001), ischemic heart disease (1.24, P<0.0001), recipient cytomegalovirus positivity (1.16, P=0.003), tobacco use (1.16, P=0.02), tacrolimus use at discharge (1.85 for tacrolimus vs. cyclosporine use, P<0.0001), and use of steroids at discharge (2.59 for steroid use vs. none, P=0.008).

CONCLUSIONS

NODM is common and occurs in more than a quarter of heart recipients during the median follow-up period of 2 years. Risk factors for NODM after heart transplant are similar to those reported in other solid organ transplants. Some of these factors, such as BMI and immunosuppressive regimen, are potentially modifiable.

摘要

背景

本研究旨在利用器官获取与移植网络/器官共享联合网络数据库，观察成年心脏受者新发糖尿病（NODM）的发病率，并确定其发病风险因素。

方法

2004 年 7 月至 2007 年 12 月，4972 例年龄≥18 岁的成人接受了首次单独心脏移植，并至少有一次移植后糖尿病状态的随访报告。其中 3763 例受者在移植前未患有糖尿病。采用多变量 Cox 回归分析，以 NODM 诊断时间作为时变终点，探讨 NODM 的发病风险因素。

结果

在 3763 例无移植前糖尿病的受者中，有 1075 例（28.6%）报告发生 NODM（中位随访时间 713 天）。NODM 的独立发病风险因素包括年龄较大（年龄≥50 岁者发病风险比[HR]为 1.20，<50 岁者为 1.00，P=0.01）、非白种人（白人 HR 为 1.00，非白人 HR 为 0.70，P<0.0001）、较高的体重指数（BMI）（BMI≥25 者 HR 为 1.55，<25 者 HR 为 1.00，P<0.0001）、缺血性心脏病（HR 为 1.24，P<0.0001）、受者巨细胞病毒阳性（HR 为 1.16，P=0.003）、吸烟（HR 为 1.16，P=0.02）、出院时使用他克莫司（HR 为 1.85，使用他克莫司者 HR 为 1.00，使用环孢素者 HR 为 1.16，P<0.0001）、以及出院时使用类固醇（HR 为 2.59，使用类固醇者 HR 为 1.00，不使用者 HR 为 1.16，P=0.008）。