Pretransplant Homeostasis Model Assessment of Insulin Resistance and Fasting Plasma Glucose Predict New-Onset Diabetes After Renal Transplant in Chinese Patients
Pretransplant Homeostasis Model Assessment of Insulin Resistance and Fasting Plasma Glucose Predict New-Onset Diabetes After Renal Transplant in Chinese Patients
复制标题
移植前胰岛素抵抗和空腹血糖稳态模型评估可预测中国患者肾移植后新发糖尿病
DOI：
10.1016/j.transproceed.2019.01.062
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发表时间：
2019-04-01
影响因子：
0.9
通讯作者：
Xing, Y.
中科院分区：
文献类型：
--
作者：
Cai, R.;Wu, M.;Xing, Y.
背景和目的。本研究旨在确定稳态模型评估胰岛素抵抗指数(HOMA-IR)、空腹血糖(FPG)和血浆胰岛素(INS)是否能够预测肾移植患者移植后新发糖尿病(NODAT)的发生。我们对123名接受首次肾移植的非糖尿病患者进行了单中心回顾性研究。NODAT是在移植后1个月至1年内确诊的。采用单因素和多因素分析，包括Logistic回归分析和COX比例风险模型，分析了NODAT的潜在移植前危险因素。26.8%(33/123)的受者在移植后第一年发生NODAT。NODAT患者的HOMA-IR指数高于非NODAT患者，空腹血糖和胰岛素水平高于非NODAT患者。有趣的是，我们一致发现，空腹血糖(Logistic：优势比[OR]，3.17[1.41-6.45]；P=0.01；COX：OR，2.75[1.26-4.56]；P=0.02)和HOMA-IR指数(LOGISTIC：OR，1.73[1.21-2.87]；P=0.02；COX：OR，1.72[1.21-2.46]；P=0.002)都有力地预测了NODAT的发展。然而，这些分析表明，血浆INS和Hb A(1c)与NODAT无关。我们的研究结果表明，移植前HOMA-IR和空腹血糖是中国首次接受肾移植的非糖尿病患者发生NODAT的独立预测因子。
Background and Aim. The present study aims to determine if homeostasis model assessment of insulin resistance (HOMA-IR) index, fasting plasma glucose (FPG), and plasma insulin (Ins) are able to predict development of new onset diabetes after transplant (NODAT) for kidney recipients.Methods. We performed a single-center retrospective study of 123 nondiabetic patients receiving a first renal transplant. The NODAT was diagnosed between 1 month and 1 year post transplant. Both univariate and multivariable analyses, including logistic regression analysis and Cox proportional hazards model, were applied to dissect potential pretransplant risk factors of NODAT.Results. A total of 26.8% (33/123) of recipients developed NODAT in the first year post transplant. The NODAT patients showed higher HOMA-IR index and increased levels of FPG and Ins than non-NODAT. Interestingly, we consistently revealed that both FPG (logistic: odds ratio [OR], 3.17 [1.41-6.45]; P = .01; Cox: OR, 2.75 [1.26-4.56]; P = .02) and HOMA-IR index (logistic: OR, 1.73 [1.21-2.87]; P = .02; Cox: OR, 1.72 [1.21-2.46]; P = .002) robustly predicted the development of NODAT. However, these analyses showed that neither plasma Ins nor hemoglobin A(1c) was associated with NODAT.Conclusion. Our findings suggest that pretransplant HOMA-IR and FPG are independent predictors for the development of NODAT in Chinese nondiabetic patients receiving a first renal transplant.