António Natália, Prieto David, Providência Luís A, Antunes Manuel J
Serviço de Cardiologia dos Hospitais da Universidade de Coimbra e Clínica Universitària de Cardiologia da Faculdade de Medicina de Coimbra, Coimbra, Portugal.
Rev Port Cardiol. 2010 Feb;29(2):205-20.
Heart transplantation remains the gold standard treatment for selected patients with end-stage heart failure. However, transplantation in diabetic patients remains controversial. The hyperglycemic effect of immunosuppressant therapy further complicates posttransplantation management of diabetes and, although this is still unproven, could be responsible for a higher incidence of post-transplantation infection, rejection and mortality. In this study, we aimed to compare one-year outcomes of survival and morbidity after cardiac transplantation among recipients with and without diabetes mellitus.
This was a prospective observational study of 114 patients who underwent first heart transplantation between November 2003 and January 2008, with 1-year follow-up. They were divided into two groups according to whether they had pre-transplantation diabetes (group 1) or not (group 2). Baseline variables and complications were recorded. Logistic regression analysis was used to identify independent predictors of 1-year mortality.
Of the 114 patients, 33% were diabetic before transplantation. Diabetic patients were older (57.0 +/- 7.4 vs. 51.2 +/- 12.9 years, p = 0.013), and had a higher prevalence of hypertension (63.6% vs. 16.7%, p = 0.002), lower creatinine clearance (53.5 +/- 16.2 vs. 63.0 +/- 21.8 ml/min, p = 0.020) and higher C-reactive protein levels (1.8 +/- 2.4 vs. 0.9 +/- 1.3 mg/l, p = 0.029) than non-diabetics. They tended to have more peripheral arterial disease (20.8 vs. 14.8%, p = NS) and carotid disease (25.8 vs. 14.3%, p = NS). In diabetic patients fasting glucose levels were significantly lower at one year than before heart transplantation (134.2 +/- 45.3 vs. 158.4 +/- 71.2 mg/dl, p = 0.039). There were no significant differences between diabetic and non-diabetic patients in rejection (16.2 vs. 23.4%, p = 0.467), infection (27.0 vs. 33.8%, p = 0.524) or mortality (16.2 vs. 6.5%, p = 0.171) at 1-year follow-up. On logistic regression analysis, the only predictor of 1-year mortality was baseline creatinine > 1.4 mg/dl (OR: 6.36, 95% CI: 1.12-36.04). Diabetes and impaired fasting glucose before heart transplantation were not independent predictors of 1-year mortality.
These data suggest that diabetes is not associated with worse 1-year survival or higher morbidity in heart transplant patients, as long as good blood glucose control is maintained.
心脏移植仍是特定终末期心力衰竭患者的金标准治疗方法。然而，糖尿病患者的心脏移植仍存在争议。免疫抑制治疗的高血糖效应使移植后糖尿病的管理更加复杂，尽管这一点尚未得到证实，但可能是移植后感染、排斥反应和死亡率较高的原因。在本研究中，我们旨在比较糖尿病患者和非糖尿病患者心脏移植后一年的生存和发病结局。
这是一项对2003年11月至2008年1月期间接受首次心脏移植的114例患者进行的前瞻性观察研究，随访1年。根据移植前是否患有糖尿病将他们分为两组（第1组）或未患糖尿病（第2组）。记录基线变量和并发症。采用逻辑回归分析确定1年死亡率的独立预测因素。
在114例患者中，33%在移植前患有糖尿病。糖尿病患者年龄较大（57.0±7.4岁对51.2±12.9岁，p = 0.013），高血压患病率较高（63.6%对16.7%，p = 0.002），肌酐清除率较低（53.5±16.2对63.0±21.8 ml/min，p = 0.020），C反应蛋白水平较高（1.8±2.4对0.9±1.3 mg/l，p = 0.029）。他们外周动脉疾病（20.8%对14.8%，p = 无显著性差异）和颈动脉疾病（25.8%对14.3%，p = 无显著性差异）的发生率往往更高。糖尿病患者1年时的空腹血糖水平显著低于心脏移植前（134.2±45.3对158.4±71.2 mg/dl，p = 0.039）。在1年随访时，糖尿病患者和非糖尿病患者在排斥反应（16.2%对23.4%，p = 0.467）、感染（27.0%对33.8%，p = 0.524）或死亡率（16.2%对6.5%，p = 0.171）方面无显著差异。逻辑回归分析显示，1年死亡率的唯一预测因素是基线肌酐>1.4 mg/dl（比值比：6.36，95%置信区间：1.12 - 36.04）。心脏移植前的糖尿病和空腹血糖受损不是1年死亡率的独立预测因素。
这些数据表明，只要维持良好的血糖控制，糖尿病与心脏移植患者1年生存率较差或发病率较高无关。
