Cardiovascular consequences of new-onset hyperglycemia after kidney transplantation.
Cardiovascular consequences of new-onset hyperglycemia after kidney transplantation.
复制标题
DOI：
10.1097/tp.0b013e3182584831
复制
发表时间：
2012-08-27
期刊：
影响因子：
6.2
通讯作者：
Torres VE
中科院分区：
文献类型：
--
作者：
Wauters RP;Cosio FG;Suarez Fernandez ML;Kudva Y;Shah P;Torres VE
移植后新发糖尿病（NODAT）与高心血管（CV）风险和患者生存率降低相关。尚不清楚该风险是新获得的还是代表该并发症患者中既存的CV疾病。其中包括1146名成年人，他们在1984年至2008年期间接受了首次肾移植，并接受了现代免疫抑制剂治疗。移植后一年，29.8%的患者出现空腹血糖受损，13.4%的患者出现NODAT受损。NODAT的风险与受体变量相关，包括：年龄较大，男性，较高的体重指数，较高的移植前葡萄糖和甘油三酯水平，以及较低的高密度脂蛋白水平。移植后1、4或12个月空腹血糖水平升高，与其他因素无关，与患者生存率降低相关（12个月风险比[HR]=1.146 [1.132-1.161]，血糖升高10 mg/dL，P<0.0001），这主要是因为CV死亡增加。高血压与所有主要CV事件（MCVE）、心脏（HR=1.113 [1.094-1.132]，P<0.0001）、血管（HR=1.168 [1.140-1.197]，P<0.0001）和卒中（HR=1.156 [1.123-1.191]，P=0.003）相关。这些关系在统计学上独立于其他风险因素。移植前无MCVE的患者发生MCVE的危险性明显增加（HR=1.145 [1.126-1.165]，P<0.0001）。此外，在移植后MCVE患者中（n=123，11%），高血糖增加死亡风险（NODAT：HR=2.410 [1.125-5.162]，P=0.024）。移植后高血糖是MCVE和死亡的一个强独立危险因素，主要由CV原因引起。这种风险与移植前发现的CV疾病无关。
New-onset diabetes after transplantation (NODAT) is associated with high cardiovascular (CV) risk and reduced patient survival. It is unclear whether this risk is newly acquired or represents preexisting CV disease in patients with this complication. Included are 1146 adults, recipients of first kidney transplants from 1984 to 2008 treated with modern immunosuppressants. One year after transplantation, 29.8% of patients experienced impaired fasting glycemia and 13.4% NODAT. The risk of NODAT related to recipient variables include the following: older age, male gender, higher body mass index, higher pretransplantation glucose and triglyceride levels, and lower high-density lipoprotein level. Increasing fasting glucose levels at 1, 4, or 12 months after transplantation, independent of other factors, related to reduced patient survival (12 months hazard ratio [HR]=1.146 [1.132–1.161], P<0.0001 for 10mg/dL increase in glucose), and this was primarily because of an increase in CV deaths. Hyperglycemia related to all major CV events (MCVE), cardiac (HR=1.113 [1.094–1.132], P<0.0001), vascular (HR=1.168 [1.140–1.197], P<0.0001), and strokes (HR=1.156 [1.123–1.191], P=0.003). These relations were statistically independent of other risk factors. The increased risk of MCVE was noted particularly in patients without MCVE before transplantation (HR=1.145 [1.126–1.165], P<0.0001). Furthermore, among patients with after transplantation MCVE (n=123, 11%), hyperglycemia increases the risk of death (NODAT: HR=2.410 [1.125–5.162], P=0.024). After transplantation hyperglycemia is a strong independent risk factor for MCVE and death, mainly from CV causes. This risk is independent of the presence of CV disease identified before transplantation.