Stress burden related to postreperfusion syndrome may aggravate hyperglycemia with insulin resistance during living donor liver transplantation: A propensity score-matching analysis.
Stress burden related to postreperfusion syndrome may aggravate hyperglycemia with insulin resistance during living donor liver transplantation: A propensity score-matching analysis.
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DOI：
10.1371/journal.pone.0243873
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Chae MS
中科院分区：
文献类型：
--
作者：
Chae S;Choi J;Lim S;Choi HJ;Park J;Hong SH;Park CS;Choi JH;Chae MS
我们使用倾向评分 (PS) 匹配分析，研究了活体肝移植 (LDLT) 患者移植物再灌注后术中期间，再灌注综合征 (PRS) 对高血糖发生和连接 (C) 肽释放的影响，连接肽 (C) 肽释放可作为胰岛素抵抗的替代标志物。回顾性审查了 324 名接受选择性 LDLT 的成年患者的医疗记录，并使用 PS 匹配方法根据 PRS 发生情况（PRS 组与非 PRS 组）对数据进行分析。在每个手术阶段通过动脉或静脉管线测量术中血糖和C肽水平。高血糖定义为峰值葡萄糖水平> 200 mg/dL，空腹状态下C肽的正常血浆浓度范围为0.5至2.0 ng/mL。 PS匹配后，各组之间术前和术中的受者发现以及供体移植物发现没有显着差异。尽管两组的血糖和C肽水平在整个手术阶段持续升高，但PRS组新生肝期的葡萄糖和C肽水平显着高于非PRS组，并且在无肝前期和新生肝期之间观察到更大的水平变化。与没有 PRS 的患者相比，PRS 患者在新肝期 C 肽水平 >2.0 ng/mL 和峰值葡萄糖水平 >200 mg/dL 的发生率更高。在有或没有外源性胰岛素输注的情况下，根据 PS 调整 PRS 与新生肝期高血糖的发生显着相关。阐明 PRS 与高血糖发生之间的关联将有助于为接受 LDLT 的患者制定术中血糖控制的标准方案。
We investigated the impact of postreperfusion syndrome (PRS) on hyperglycemia occurrence and connecting (C) peptide release, which acts as a surrogate marker for insulin resistance, during the intraoperative period after graft reperfusion in patients undergoing living donor liver transplantation (LDLT) using propensity score (PS)-matching analysis. Medical records from 324 adult patients who underwent elective LDLT were retrospectively reviewed, and their data were analyzed according to PRS occurrence (PRS vs. non-PRS groups) using the PS-matching method. Intraoperative levels of blood glucose and C-peptide were measured through the arterial or venous line at each surgical phase. Hyperglycemia was defined as a peak glucose level >200 mg/dL, and normal plasma concentrations of C-peptide in the fasting state were taken to range between 0.5 and 2.0 ng/mL. After PS matching, there were no significant differences in pre- and intra-operative recipient findings and donor-graft findings between groups. Although glucose and C-peptide levels continuously increased through the surgical phases in both groups, glucose and C-peptide levels during the neohepatic phase were significantly higher in the PRS group than in the non-PRS group, and larger changes in levels were observed between the preanhepatic and neohepatic phases. There were higher incidences of C-peptide levels >2.0 ng/mL and peak glucose levels >200 mg/dL in the neohepatic phase in patients with PRS than in those without. PRS adjusted for PS with or without exogenous insulin infusion was significantly associated with hyperglycemia occurrence during the neohepatic phase. Elucidating the association between PRS and hyperglycemia occurrence will help with establishing a standard protocol for intraoperative glycemic control in patients undergoing LDLT.
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