Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cardiovasc Diabetol. 2019 Oct 11;18(1):132. doi: 10.1186/s12933-019-0939-5.
Diabetes mellitus (DM) is a major cause of morbidity and mortality following heart transplantation (HT), with 21% and 35% of survivors being affected within 1 and 5 years following HT, respectively. Magnesium deficiency is common among HT patients treated with calcineurin inhibitors and is a known risk factor for DM in non-HT patients. We therefore investigated the association between serum Mg (s-Mg) levels and new-onset diabetes after transplantation (NODAT).
Between 2002 and 2017, 102 non-DM HT patients were assessed. In accordance with the mean value of all s-Mg levels recorded during the first year post-HT, patients were divided into high s-Mg (≥ 1.8 mg/dL) and low s-Mg (< 1.8 mg/dL) groups. The endpoint was NODAT, defined according to the diagnostic criteria of the American Diabetes Association.
Baseline clinical and demographic characteristics for the high (n = 45) and low s-Mg (n = 57) groups were similar. Kaplan-Meier survival analysis showed that 15-year freedom from NODAT was significantly higher among patients with high vs low s-Mg (85% vs 46% log-rank test, p < 0.001). Consistently, multivariate analysis adjusted for age, gender, immunosuppression therapies, BMI and mean creatinine values in the first year post-HT, showed that low s-Mg was independently associated with a significant > 8-fold increased risk for NODAT (95% CI 2.15-32.63, p = 0.003). Stroke rate was significantly higher in patients with low s-Mg levels vs high s-Mg (14% vs 0, p = 0.025), as well as long term mortality (HR 2.6, 95% CI 1.02-6.77, p = 0.05).
Low s-Mg level post-HT is an independent risk factor for NODAT in HT patients. The implications of interventions, focusing on preventing or correcting low s-Mg, for the risk of NODAT and for clinical outcomes should be evaluated.
糖尿病（DM）是心脏移植（HT）后发病率和死亡率的主要原因，分别有 21%和 35%的幸存者在 HT 后 1 年和 5 年内受到影响。接受钙调神经磷酸酶抑制剂治疗的 HT 患者中普遍存在镁缺乏，镁缺乏是 HT 患者发生糖尿病的已知危险因素。因此，我们研究了血清镁（s-Mg）水平与移植后新发糖尿病（NODAT）之间的关系。
在 2002 年至 2017 年间，评估了 102 例非糖尿病 HT 患者。根据 HT 后第一年记录的所有 s-Mg 水平的平均值，患者被分为高 s-Mg（≥1.8mg/dL）和低 s-Mg（<1.8mg/dL）组。终点是 NODAT，根据美国糖尿病协会的诊断标准定义。
高 s-Mg（n=45）和低 s-Mg（n=57）组的基线临床和人口统计学特征相似。Kaplan-Meier 生存分析显示，高 s-Mg 组与低 s-Mg 组相比，15 年无 NODAT 的比例显著更高（对数秩检验，85% vs 46%，p<0.001）。同样，多变量分析调整了年龄、性别、免疫抑制治疗、BMI 和 HT 后第一年的平均肌酐值，结果表明低 s-Mg 与 NODAT 的风险显著增加 8 倍以上相关（95%CI 2.15-32.63，p=0.003）。低 s-Mg 组的卒中发生率明显高于高 s-Mg 组（14% vs 0，p=0.025），长期死亡率也明显更高（HR 2.6，95%CI 1.02-6.77，p=0.05）。
HT 后低 s-Mg 水平是 HT 患者 NODAT 的独立危险因素。应评估针对预防或纠正低 s-Mg 以降低 NODAT 风险和改善临床结局的干预措施的意义。
