Glucose intolerance after renal transplantation depends upon prednisolone dose and recipient age
Glucose intolerance after renal transplantation depends upon prednisolone dose and recipient age
复制标题
DOI：
10.1097/00007890-199710150-00008
复制
发表时间：
1997-10-15
期刊：
影响因子：
6.2
通讯作者：
Fauchald, P
中科院分区：
文献类型：
--
作者：
Hjelmesaeth, J;Hartmann, A;Fauchald, P
背景回顾性研究表明，在接受三联药物免疫抑制治疗的患者中，移植后糖尿病（PTDM）的患病率具有很大的分散性，而移植后糖耐量受损（IGT）的发病率尚不清楚。我们研究的目的是前瞻性地检查移植后葡萄糖耐受不良的发病率，并评估潜在的危险因素。对173例连续肾移植受者在移植后10周通过口服葡萄糖耐量试验（n = 167）或确诊为显性糖尿病（n = 6）前瞻性检查葡萄糖耐受不良。单因素分析显示，年龄、糖尿病家族史、HLA-B27表型、DR错配、排斥反应、泼尼松龙实际剂量、甲泼尼龙总剂量、类固醇总剂量、巨细胞病毒（CMV）感染和使用呋塞米与PTDM相关。年龄、泼尼松龙剂量、CMV感染和β受体阻滞剂的使用与IGT相关，性别、体重指数、供体来源和环孢素水平不影响糖耐量，泼尼松龙剂量、年龄、糖尿病家族史、CMV感染和HLA-B27表型是PTDM的独立预测因子，采用多元逐步logistic回归分析，年龄、泼尼松龙剂量、单变量和多变量线性回归分析均显示2小时血糖与泼尼松龙剂量之间存在显著相关性，泼尼松龙剂量每增加0.01 mg/kg/d，发生PTDM的风险为5%。泼尼松龙剂量增加和年龄增大与移植后葡萄糖耐受不良的发生密切相关。
Background. Retrospective studies on the prevalence of posttransplant diabetes mellitus (PTDM) in patients on triple-drug immunosuppressive therapy have shown great dispersity, while the incidence of posttransplant impaired glucose tolerance (IGT) is unknown, The aim of our study was to prospectively examine the incidence of posttransplant glucose intolerance and to assess potential risk factors,Methods, Glucose intolerance was prospectively examined in 173 consecutive kidney transplant recipients by oral glucose tolerance tests (n = 167) or the diagnosis of manifest diabetes mellitus (n = 6) at 10 weeks after transplant,Results, We found a high incidence of PTDM (18%) and IGT (31%), Univariate analysis revealed that age, family history of diabetes, HLA-B27 phenotype, DR mismatch, rejection, actual prednisolone dose, total methylprednisolone dose, total steroid dose, cytomegalovirus (CMV) infection, and the use of furosemide were associated with PTDM. Age, prednisolone dose, CMV infection, and the use of beta-blockers were associated with IGT, Gender, body mass index, donor source, and cyclosporine level did not influence glucose tolerance, Prednisolone dose, age, family history of diabetes, CMV infection, and HLA-B27 phenotype were independent predictors of PTDM with the use of multiple stepwise logistic regression analysis, Age, prednisolone dose, and the use of a beta-blocker were associated with IGT in the multivariate model, Both univariate and multivariate linear regression analysis revealed a significant relationship between the 2-hr serum glucose and prednisolone dose, The risk of developing PTDM was 5% per 0.01 mg/kg/day of increase in prednisolone dose,Conclusions, Increased prednisolone dose and older age are strongly associated with the development of posttransplant glucose intolerance.