Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
J Thorac Cardiovasc Surg. 2015 Sep;150(3):707-13.e2. doi: 10.1016/j.jtcvs.2015.06.041. Epub 2015 Jun 26.
The influence of diabetes mellitus (DM) on survival in patients with cystic fibrosis (CF) before and after lung transplantation is not well studied.
To determine the influence of DM in patients with CF, the United Network for Organ Sharing database (2005-2013) was queried for 2 cohorts: first-time lung transplant candidates who were not transplanted and first-time transplant recipients.
A total of 679 patients with CF had data on DM status at listing and did not undergo transplantation. In this cohort, DM was associated with significant increase in mortality hazard as shown by an adjusted multivariate Cox model fitted to the whole cohort (hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.1-1.8; P = .012) and by a Cox model stratified on pairs of DM and non-DM patients matched on the propensity of having DM at listing (HR, 1.9; 95% CI, 1.2-2.9; P = .003). In comparison, a total of 1464 patients with CF had data on DM status at listing and received a transplant, but DM at listing was not associated with posttransplant survival. The lack of association between DM and mortality hazard was evident in a multivariate Cox regression model fitted to the whole sample (HR, 1.0; 95% CI, 0.82-1.2; P = .98) and a Cox regression model stratified on matched pairs of DM and non-DM patients (HR, 1.1; 95% CI, 0.82-1.5; P = .56).
The presence of DM is associated with significantly increased risk for death in patients with CF on the wait list before lung transplantation, but does not influence survival after transplantation.
糖尿病（DM）对肺移植前后囊性纤维化（CF）患者生存的影响尚未得到充分研究。
为了确定 DM 对 CF 患者的影响，查询了 United Network for Organ Sharing 数据库（2005-2013 年）中的 2 个队列：未进行移植的首次肺移植候选人和首次移植受者。
共有 679 例 CF 患者在列时具有 DM 状态数据且未进行移植。在该队列中，调整后的多变量 Cox 模型拟合整个队列显示 DM 与死亡率风险显著增加（危险比[HR]，1.4；95%置信区间[CI]，1.1-1.8；P=0.012），以及按 DM 和非 DM 患者在列时的 DM 倾向进行分层的 Cox 模型（HR，1.9；95%CI，1.2-2.9；P=0.003）。相比之下，共有 1464 例 CF 患者在列时具有 DM 状态数据且接受了移植，但 DM 与移植后生存无关。多变量 Cox 回归模型拟合整个样本（HR，1.0；95%CI，0.82-1.2；P=0.98）和分层在 DM 和非 DM 患者匹配对的 Cox 回归模型（HR，1.1；95%CI，0.82-1.5；P=0.56）中，DM 与死亡率风险之间缺乏关联是明显的。
在等待肺移植时，CF 患者的 DM 存在与死亡风险显著增加相关，但不会影响移植后的生存。
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