新发糖尿病与肝移植，特别考虑丙型肝炎复发

[New-onset diabetes mellitus and liver transplantation, with special consideration of recurrent hepatitis C].

作者信息

Nemes Balázs, Gelley Fanni, Zádori Gergely, Földes Katalin, Firneisz Gábor, Görög Dénes, Fehérvári Imre, Kóbori László, Gerlei Zsuzsanna, Fazakas János, Pápai Simon, Doros Attila, Nagy Péter, Lengyel Gabriella, Schaff Zsuzsa, Sárváry Eniko

机构信息

Semmelweis Egyetem, Altalános Orvostudományi Kar Transzplantációs és Sebészeti Klinika Budapest Baross u. 23. 1082.

出版信息

Orv Hetil. 2010 Jun 27;151(26):1062-71. doi: 10.1556/OH.2010.28902.

DOI:10.1556/OH.2010.28902

PMID:20558353

Abstract

UNLABELLED

New-onset diabetes is a common complication after liver transplantation.

AIM

We aimed to analyze the incidence and rate of known risk factors and the impact of new-onset diabetes mellitus on postoperative outcome.

METHODS

We retrospectively evaluated the files of 310 patients who underwent liver transplantation between 1995 and 2009. Definition of new-onset diabetes included: repeated fasting serum glucose >6.8 mmol/l and/or sustained antidiabetic therapy that was present 3 months after transplantation.

RESULTS

New-onset diabetes occurred in 63 patients (20%). Differences between the new-onset and the control group were the donor body mass index (24+/-3 vs. 22.4+/-3.6 kg/m 2 , p = 0.003), donor male gender (58% vs. 33%, p = 0.002), and recipient age (47.6+/-7.2 vs. 38.3+/-14.6 year, p<0.001), body mass index (26.7+/-3.8 vs. 23.3+/-5.6 kg/m 2 , p<0.001), male gender (60% vs. 44%, p = 0.031). The 66% of patients with new-onset diabetes were transplanted with cirrhosis caused by hepatitis C virus infection, while in the control group the rate was 23% (p<0.001). Cumulative patient survival rates at 1, 3, 5 and 8 year were 95%, 90.6%, 88% and 88% in the control group, and 87%, 79%, 79% and 64% in the de novo group, respectively (p = 0.011). Cumulative graft survival rates at 1, 3, 5 and 8 year in the control group were 92%, 87%, 86% and 79%, in the de novo diabetes group the rates were 87%, 79%, 79%, 65%, respectively (p = NS). In case of early recurrence (in 6 months), majority of patients developed new-onset diabetes (74% vs. control 26%, p = 0.03). More patients had more than 10 times higher increase of the postoperative virus titer correlate to the preoperative titer in the de novo diabetes group (53% vs. 20%, p = 0.028). Mean fibrosis score was higher in new-onset group one year after the beginning of antiviral therapy (2.05+/-1.53 vs. 1.00+/-1.08, p = 0.039).

CONCLUSIONS

Risk factors for new-onset diabetes after transplantation are older age, obesity, male gender and cirrhosis due to hepatitis C infection. The early recurrence, viremia and more severe fibrosis after antiviral therapy have an impact on the occurrence of new-onset diabetes in hepatitis C positive patients.

摘要

未标注

新发糖尿病是肝移植后常见的并发症。

目的

我们旨在分析已知危险因素的发生率和比例，以及新发糖尿病对术后结局的影响。

方法

我们回顾性评估了1995年至2009年间接受肝移植的310例患者的病历。新发糖尿病的定义包括：多次空腹血清葡萄糖>6.8 mmol/l和/或移植后3个月开始持续的抗糖尿病治疗。

结果

63例患者（20%）发生新发糖尿病。新发糖尿病组与对照组的差异在于供体体重指数（24±3 vs. 22.4±3.6 kg/m²，p = 0.003）、供体男性性别（58% vs. 33%，p = 0.002）、受体年龄（47.6±7.2 vs. 38.3±14.6岁，p<0.001）、体重指数（26.7±3.8 vs. 23.3±5.6 kg/m²，p<0.001）、男性性别（60% vs. 44%，p = 0.031）。66%的新发糖尿病患者因丙型肝炎病毒感染导致肝硬化而接受移植，而对照组的这一比例为23%（p<0.001）。对照组1年、3年、5年和8年的累积患者生存率分别为95%、90.6%、88%和88%，新发糖尿病组分别为87%、79%、79%和64%（p = 0.011）。对照组1年、3年、5年和8年的累积移植物生存率分别为92%、87%、86%和79%，新发糖尿病组分别为87%、79%、79%、65%（p = 无显著性差异）。在早期复发（6个月内）的情况下，大多数患者发生新发糖尿病（74% vs. 对照组26%，p = 0.03）。新发糖尿病组中更多患者术后病毒滴度较术前滴度升高超过10倍（53% vs. 20%，p = 0.028）。抗病毒治疗开始1年后，新发糖尿病组的平均纤维化评分更高（2.05±1.53 vs. 1.00±1.08，p = 0.039）。