Predictors of New Onset of Diabetes after Transplantation in Stable Renal Recipients
Predictors of New Onset of Diabetes after Transplantation in Stable Renal Recipients
复制标题
稳定肾受体移植后新发糖尿病的预测因素
作者：
W. Shehab;A. Shoker
背景：几个小组确定了导致移植后新发糖尿病（NODAT）的移植前因素。目的：确定 NODAT 移植后危险因素。方法：55例病情稳定的肾移植患者分为A组34例血糖正常受者和B组21例空腹血糖受损受者。包括胰岛素、胰岛素原、晚期糖化终产物可溶性受体 (sRAGE)、脂联素、丙二醛、胰岛素抵抗稳态模型评估 (HOMA-IR) 和 β 细胞功能在内的标志物在开始时进行计算，并在 14.98 ± 3.97 个月的随访期间与后来的 NODAT 发展相关。结果：A 组和 B 组分别有 11.8% 和 19% 出现 NODAT。在单变量分析中，胰岛素、sRAGE、HOMA-IR 和基础空腹血糖与 NODAT 的发展相关。 54.54 mU/l 的基线胰岛素水平预测 NODAT 的发展，特异性为 95.45%，并且是多变量分析中唯一重要的因素。三组之间的β细胞功能没有差异。结论：在出现 NODAT 之前就存在长期的胰岛素抵抗 (IR) 前驱症状。 50% 的 NODAT 患者将缓解至正常血糖状态。 IR（而非 β 细胞功能障碍）先于 NODAT 的发生。稳定的非糖尿病肾移植患者的血清胰岛素可用作未来 NODAT 开发的验证试验。
Background: Several groups identified pre-transplant factors which contribute to the development of new onset of diabetes after transplantation (NODAT). Aim: To identify post-transplant risk factors for NODAT. Methods: 55 stable renal transplant patients were divided into group A of 34 recipients with normoglycemia and group B of 21 recipients with impaired fasting glucose. Markers including insulin, pro-insulin, soluble receptors for advanced glycated end products (sRAGE), adiponectin, malondialdehyde, homeostasis model assessment of insulin resistance (HOMA-IR), and β-cell function were calculated at the outset and correlated, thereafter, with the later development of NODAT after a follow-up duration of 14.98 ± 3.97 months. Results: 11.8 and 19% of groups A and B respectively developed NODAT. Insulin, sRAGE, HOMA-IR and basal fasting plasma glucose correlated with the development of NODAT in univariate analysis. A baseline insulin level of 54.54 mU/l predicted the development of NODAT with a specificity of 95.45% and was the only significant factor in the multivariate analysis. β-Cell function was not different among the three groups. Conclusions: A long prodrome of insulin resistance (IR) exists prior to development of NODAT. 50% of patients with NODAT will remit to a normoglycemic state. IR, rather than β-cell dysfunction, precedes the development of NODAT. Serum insulin in stable non-diabetic renal transplant patients can be used as a confirmatory test to the development of future NODAT.