Post-transplant Diabetes Mellitus in Renal Transplant Recipients-Experience in Buddhist Tzu Chi General Hospital

腎臟移植後糖尿病－慈濟醫院之臨床經驗

楊文琴(Wen-Chin Yang) ； 陳怡珊(Yi-Shan Chen) ； 陳怡珊(Yi-Shan Chen) ； 謝維清(Wei-Ching Hsieh) ； 施明蕙(Ming-Hui Shih) ； 李明哲(Ming-Che Lee)

《慈濟醫學雜誌》 18卷3期 (2006/06) Pp. 185-191

https://doi.org/10.6440/TZUCMJ.200606.0185

摘要

目的：本文主要分析腎臟移植術後病患糖尿病發生之情形，以了解相關危險因子之影響及臨床治療之結果。材料與方法：本研究採回溯性分析43位病例。資料蒐集自器官移植小組腎臟移植病患相關紀錄，包括移植時年齡、性別、移植分類、發生急性排斥、巨細胞病毒感染及糖尿病家族史等。利用SPSS 11.5版統計軟體進行統計分析，以多變項分析危險因子如移植年齡、移植分類、免疫抑制劑、急性排斥、巨細胞病毒感染等與腎臟移植後糖尿病發生率之關係。結果：本文分析腎臟移植病患發生高血糖的情形，在43位病患中發生糖尿病的有9例(20.9%)。相關危險因子分析顯示年齡大於45歲有5例，有糖尿病家族史的1例，曾發生急性排斥有4例，發生巨細胞病毒感染則有3例。於多變項分析中僅巨細胞病毒感染達統計學上意義(odds ratio (OR)=9.56；P=0.04)。免疫抑制劑的使用方面，使用以tacrolimus為主的處方較使用cyclosporine為主的處方發生率較高比例之術後糖尿病(OR=7.30；P=0.06)。其結果雖未達統計學上意義，但值得注意的是病患發生高血糖時其tacrolimus波谷濃度皆大於15ng/dL。關於發生高血糖時之初期處置方面，有4例須使用胰島素控制，有3例以口服降血糖藥物控制，有2例僅以調整免疫抑制劑及飲食控制。所有移植後糖尿病患經初期處置後皆不需再使用胰島素控制血糖。結論：病患移植術前相關危險因子評估、免疫抑制劑的選擇與調整及移植術後血糖的監測可望減少腎臟移植術後糖尿病的發生或降低嚴重程度。

關鍵字

移植後糖尿病 ； 腎臟移植 ； 免疫抑制劑

並列摘要

Objectives: To analyze the incidence of post-transplant diabetes mellitus (PTDM) in renal transplant recipients, we evaluated the related risk factors of PTDM and clinical outcome in those patients. Materials and Methods: This study retrospectively analyzed the clinical results of 43 renal transplant recipients followed in Buddhist Tzu Chi General Hospital, which included patient demographics, type of transplant, regimen of immunosuppressant, as well as the development of acute allograft rejection, cytomegalovirus infection (CMV), and PTDM. The incidence, management and risk factors of PTDM were determined. A multivariate analysis of the risk factors of PTDM, which included age at transplantation, family history of diabetes, acute allograft rejection, CMV infection and regimen of immunosuppressant, was performed using logistic regression analysis. Results: The incidence of PTDM was 20.9%. In terms of risk factors analysis for PTDM, there were five patients aged over 45 years, and one patient had family history of diabetes. Four patients were diagnosed with acute allograft rejection and three patients had CMV infection. In the multivariate analysis, only the patients with CMV infection had a higher incidence of PTDM compared with those without CMV infection (odds ratio (OR)=9.56; P=0.04). Although there was a trend for developing PTDM in patients using tacrolimus-based immunosuppressants, it was statistically not significant when the data were compared with those using cyclosporine-based regimens (OR=7.30; P=0.06). Importantly, the PTDM patients who used tacrolimus-based immunosuppressants all had high trough levels of serum tacrolimus (＞15ng/mL) when PTDM was diagnosed. In regard to the initial management of PTDM, four recipients took insulin to control their blood glucose and three took oral hypoglycemic agents (OHA). The blood glucose was controlled simply by diet and reducing dosage of immunosuppressants in two patients. None of the PTDM patients were insulin-dependent after the initial treatment. Conclusions: The pre-transplant evaluation of patients' risk factors, the choice and adjustment of immunosuppressants, scheduled monitoring of blood glucose level after renal transplantation and prompt treatment of hyperglycemia showed promise in decreasing the incidence and severity of PTDM in renal transplant recipients.

並列關鍵字

post-transplant diabetes mellitus PTDM ； renal transplantation ； immunosuppressant