Anastácio Lucilene Rezende, Ribeiro Hélem de Sena, Ferreira Livia García, Lima Agnaldo Soares, Vilela Eduardo García, Toulson Davisson Correia María Isabel
Adult Health Post Graduate Program, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Nutr Hosp. 2013 May-Jun;28(3):643-8. doi: 10.3305/nh.2013.28.3.6193.
Metabolic disorders are widely described in patients after liver transplantation (LTx).
Arterial hypertension, diabetes mellitus and obesity incidence and risk factors were assessed in 144 post-LTx patients at least one year after transplantation (59% male; median age 54 y; median time since transplantation 4 y). Risk factors were assessed using logistic regression analysis according to demographic, socioeconomic, lifestyle, clinical, anthropometric and dietetic variables.
The incidence of hypertension was 18.9%; diabetes, 14.0% and obesity, 15.9%. Risk factors for the incidence of hypertension were abdominal obesity (OR: 2.36; CI: 1.02-5.43), family history of hypertension (OR: 2.75; CI: 1.06-7.19) and cyclosporine use (OR: 3.92; CI: 1.05-14.70). Risk factor for incidence of diabetes were greater fasting glucose levels (mg/dL) pre-LTx (OR: 1.04; CI: 1.01-1.06) and on the diagnosis of alcoholic cirrhosis as an indication of LTx (OR: 2.54; CI: 0.84-7.72). The incidence of obesity after LTx was related to lower milk consumption (mL) (OR: 1.01; CI: 1.001-1.01; P < 0.05), greater donor BMI (kg/m(2)) (OR: 1.34; CI: 1.04-1.74; P < 0.05), greater BMI prior to liver disease (kg/m(2)) (OR: 1.79; CI: 1.36-2.36; P < 0.01) and a per capita income twice the minimum wage (OR: 5.71; CI: 4.51-6.86; P < 0.05).
LTx was associated with significantly increased rates of hypertension, diabetes and obesity. Furthermore, the incidences of these disorders were related to immunosuppressive therapy and have risk factors that are common in the general population.
肝移植(LTx)术后患者中代谢紊乱的情况被广泛报道。
对144例肝移植术后至少一年的患者评估动脉高血压、糖尿病和肥胖的发病率及危险因素(59%为男性;中位年龄54岁;移植后中位时间4年)。根据人口统计学、社会经济、生活方式、临床、人体测量和饮食变量,采用逻辑回归分析评估危险因素。
高血压发病率为18.9%;糖尿病为14.0%,肥胖为15.9%。高血压发病的危险因素为腹型肥胖(比值比:2.36;可信区间:1.02 - 5.43)、高血压家族史(比值比:2.75;可信区间:1.06 - 7.19)和使用环孢素(比值比:3.92;可信区间:1.05 - 14.70)。糖尿病发病的危险因素为肝移植术前空腹血糖水平较高(mg/dL)(比值比:1.04;可信区间:1.01 - 1.06)以及以酒精性肝硬化作为肝移植指征(比值比:2.54;可信区间:0.84 - 7.72)。肝移植术后肥胖的发病率与牛奶摄入量较低(mL)有关(比值比:1.01;可信区间:1.001 - 1.01;P < 0.05)、供体体重指数(kg/m²)较高(比值比:1.34;可信区间:1.04 - 1.74;P < 0.05)、肝病前体重指数较高(kg/m²)(比值比:1.79;可信区间:1.36 - 2.36;P < 0.01)以及人均收入是最低工资的两倍(比值比:5.71;可信区间:4.51 - 6.86;P < 0.05)。
肝移植与高血压、糖尿病和肥胖的发生率显著增加相关。此外,这些疾病的发生率与免疫抑制治疗有关,且具有一般人群中常见的危险因素。