天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (8): 726-730.doi: 10.11958/20193873

• 临床研究 • 上一篇    下一篇

体质量指数与接受成人脂肪肝供体的肝移植术后糖尿病关系探讨#br#

郝明月1，喻文立2，盛明薇2，孙琳琳3，张馨月1，乌曼1，杜洪印2△   

  1. 1天津医科大学一中心临床学院（邮编300192）；2天津市第一中心医院；3南开大学医学院
  • 收稿日期:2019-12-24 修回日期:2020-04-16 出版日期:2020-08-15 发布日期:2020-08-12
  • 通讯作者: 杜洪印 E-mail:duhongyin@sina.com
  • 作者简介:郝明月（1992），女，硕士在读，主要从事肝移植相关研究
  • 基金资助:
    国家自然科学基金青年项目（81700659）；天津市自然科学基金面上项目（18JCYBJC27500、17JCYBJC28000）；天津市临床重点学科（麻醉学科）建设项目；天津市卫生和计划生育委员会中医中西医结合科研课题（2017056）；天津市卫生计生委科技攻关项目（16KG101）

Relationship between body mass index and new-onset diabetes after liver transplantation using steatotic grafts#br#

HAO Ming-yue1, YU Wen-li2, SHENG Ming-wei2, SUN Lin-lin3, ZHANG Xin-yue1, WU Man1, DU Hong-yin2△   

  • Received:2019-12-24 Revised:2020-04-16 Published:2020-08-15 Online:2020-08-12
  • Contact: DU Hong-yin E-mail:duhongyin@sina.com

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摘要： 目的　探讨体质量指数（BMI）与接受成人脂肪肝供体的肝移植术后新发糖尿病（NODAT）的关系。方法　对接受成人脂肪肝供体的肝移植术的181例患者资料进行回顾性分析，其中消瘦组5例（BMI＜18.5 kg/m2），正常组82例（18.5 kg/m2≤BMI＜24 kg/m2），超重组65例（24 kg/m2≤BMI＜28 kg/m2），肥胖组29例（BMI≥28 kg/m2）。又根据患者有无NODAT，分为NODAT组57例和非NODAT组124例。比较各组受体的一般资料、术后并发症的差异。利用二元Logistic回归分析影响脂肪肝供体肝移植NODAT的危险因素，并绘制Kaplan-Meier生存曲线对患者肝移植术后1、3、5年累积生存率进行分析。结果　肥胖组术前血清白蛋白低于正常组和超重组（P＜0.05）；超重组和肥胖组患者NODAT发生率高于正常组（P＜0.01），肥胖组患者NODAT发生率高于消瘦组和超重组（P＜0.05）；二元Logistic回归分析示，超重（OR=3.423，95%CI：1.410~8.310）和肥胖（OR=16.808，95%CI：6.023~46.907）是脂肪肝供体肝移植NODAT发生的独立危险因素；生存曲线显示，肥胖组5年累积生存率明显低于其他3组（Log-rank χ2=44.998，P＜0.01）。结论　超重和肥胖是成人脂肪肝供体肝移植NODAT发生的危险因素，术前合理控制患者BMI可显著改善移植预后。
关键词：人体质量指数；肝移植；糖尿病；移植术后新发糖尿病；脂肪肝供体肝移植

关键词: 人体质量指数, 肝移植, 糖尿病, 移植术后新发糖尿病, 脂肪肝供体肝移植

Abstract: Objective　To explore the correlation between different body mass index (BMI) and new-onset diabetes (NODAT) after steatotic liver transplantation in adults. Methods　The clinical data of 181 patients who underwent steatotic liver transplantation were retrospectively analyzed. Patients were divided into four groups including 5 patients in the thin group (BMI＜18.5 kg/m2), 82 patients in the normal group (18.5 kg/m2≤BMI＜24 kg/m2), 65 patients in the overweight group (24 kg/m2≤BMI＜28 kg/m2) and 29 patients in the obese group (BMI≥28 kg/m2). Clinical data, incidence of complications and accumulated survival rates were compared between 4 groups. Binary Logistic regression were used to assess the risk factors of diabetes after steatotic liver transplantation, and the Kaplan-Meier survival curves were drawn to analyze the 1-year,3-year and 5-year cumulative survival rates of patients. Results　The serum albumin level was significantly lower in the obese group than that of the normal group and overweight group (P＜0.05). Compared with the normal group, the incidence of NODAT was significantly increased in the overweight group and obese group (P＜0.01).The incidence of NODAT was significantly higher in the obese group than that of the overweight group (P＜0.01). The incidence of NODAT was significantly higher in the obese group than that of the thin group (P＜0.05). Logistic analysis showed that the over weight (OR=3.423,95%CI:1.410-8.310) and obesity (OR=16.808,95%CI:6.023-46.907) were independent risk factors in the development of NODAT in steatotic liver transplantation (OR=1.363，95% CI：1.214-1.530). Survival curves revealed that the survival rate of the obese group was observably lower than that of the other 3 groups (Log-rank χ2=44.998，P＜0.01). Conclusion　Overweight and obesity are independent risk factor for the occurrence of NODAT after steatotic liver transplantation, and rational control of BMI before surgery can significantly improve the prognosis.

Key words: body mass index, liver transplantation, diabetes mellitus, new-onset diabetes after transplantation, steatotic liver transplantation

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