Byambasukh Oyuntugs, Osté Maryse C J, Gomes-Neto António W, van den Berg Else, Navis Gerjan, Bakker Stephan J L, Corpeleijn Eva
Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
Department of Internal Medicine, Mongolian National University of Medical Sciences, 976 Ulaanbaatar, Mongolia.
J Clin Med. 2020 Feb 3;9(2):415. doi: 10.3390/jcm9020415.
(1) Background: Little is currently known about the health impacts of daily-life moderate-to-vigorous physical activity (MVPA) in relation to the development of post-transplant diabetes mellitus (PTDM) and the long-term survival of renal transplant recipients (RTRs). (2) Methods: We analyzed self-reported data on MVPA within non-occupational and occupational domains, estimated with the SQUASH questionnaire, from a prospective cohort study of RTRs ( = 650) with a functioning graft exceeding 1 year. PTDM diagnoses were based on plasma glucose levels (≥126 mg/dL), HbA1c (≥6.5%), and the use of antidiabetic medication. Mortality data were retrieved from patient files up to the end of September 2015. (3) Results: During a median follow-up period of 5.3 years, 50 patients (10%) developed PTDM and 129 (19.8%) died. Of these deaths, 53 (8.9%) were caused by cardiovascular disease. Cox regression analyses showed that higher MVPA levels among patients were associated with a lower risk of PTDM (hazard ratio (HR); 95% confidence interval (95%CI) = 0.49; 0.25-0.96, = 0.04), cardiovascular- (0.34; 0.15-0.77, = 0.01), and all-cause mortality (0.37; 0.24-0.58, < 0.001) compared with No-MVPA patients, independently of age, sex, and kidney function parameters. Associations of MVPA with cardiovascular and all-cause mortality remained significant and materially unchanged following further adjustments made for transplant characteristics, lifestyle factors, metabolic parameters, medication use, and creatinine excretion (muscle mass). However, the association between MVPA and PTDM was no longer significant after we adjusted for metabolic confounders and glucose levels. (4) Conclusion: Higher MVPA levels are associated with long-term health outcomes in RTRs.
(1) 背景：目前对于日常生活中中度至剧烈身体活动（MVPA）对肾移植受者（RTR）发生移植后糖尿病（PTDM）及长期生存的健康影响知之甚少。(2) 方法：我们分析了一项针对移植肾功能超过1年的RTR前瞻性队列研究（n = 650）中通过SQUASH问卷估算的非职业和职业领域内MVPA的自我报告数据。PTDM诊断基于血糖水平（≥126 mg/dL）、糖化血红蛋白（HbA1c，≥6.5%）以及抗糖尿病药物的使用情况。死亡率数据截至2015年9月底从患者病历中获取。(3) 结果：在中位随访期5.3年期间，50例患者（10%）发生了PTDM，129例（19.8%）死亡。其中，53例（8.9%）死于心血管疾病。Cox回归分析显示，与无MVPA的患者相比，患者中较高的MVPA水平与较低的PTDM风险（风险比（HR）；95%置信区间（95%CI）= 0.49；0.25 - 0.96，P = 0.04）、心血管疾病（0.34；0.15 - 0.77，P = 0.01）及全因死亡率（0.37；0.24 - 0.58，P < 0.001）相关，且独立于年龄、性别和肾功能参数。在对移植特征、生活方式因素、代谢参数、药物使用和肌酐排泄（肌肉量）进行进一步调整后，MVPA与心血管疾病及全因死亡率的关联仍然显著且基本不变。然而，在我们对代谢混杂因素和血糖水平进行调整后，MVPA与PTDM之间的关联不再显著。(4) 结论：较高的MVPA水平与RTR的长期健康结局相关。
