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浙江大学学报(医学版)  2021, Vol. 50 Issue (2): 239-244    DOI: 10.3724/zdxbyxb-2021-0114
原著     
肝移植受者术后早期血清甘油三酯变化规律及其对术后糖尿病的预测价值
吴懿1(),蒋巍亮2,杨晓军2,黎文华2,万荣2,陆伦根2,樊军卫1,卢战军2,*()
1.上海交通大学附属第一人民医院肝胆外科,上海 200080
2.上海交通大学附属第一人民医院消化科,上海 200080
Postoperative serum triglyceride levels in predicting risk of new-onset diabetes mellitus in patients following liver transplantation
WU Yi1(),JIANG Weiliang2,YANG Xiaojun2,LI Wenhua2,WAN Rong2,LU Lungen2,FAN Junwei1,LU Zhanjun2,*()
1. Department of Hepatobiliary Surgery, Shanghai General Hospital, Shanghai 200080, China;
2. Department of Gastroenterology, Shanghai General Hospital, Shanghai 200080, China
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摘要:

目的:探讨同种异体肝移植受者术后早期血清甘油三酯的变化规律及其对肝移植术后糖尿病(NODM)的临床预测价值。方法:收集上海交通大学附属第一人民医院 2007 年 7 月至 2014 年 7 月共 143 例肝移植受者(33 例发生 NODM)的术后临床资料。绘制患者肝移植术后甘油三酯的变化曲线;采用单因素和多因素 Logistic 回归分析 NODM 发生的独立危险因素,绘制受试者操作特征(ROC)曲线,记录曲线下面积,分析肝移植术后早期甘油三酯预测 NODM 发生的临床价值。结果:肝移植受者术后甘油三酯逐步上升,术后一周到达平稳期。NODM 组平稳期甘油三酯(sTG)水平显著高于无 NODM 组(Z=–2.31,P<0.05)。Logistic 回归分析结果显示,术后激素治疗(OR=4.054,P<0.01)、术后第一周他克莫司浓度(OR=3.482,P<0.05)和 sTG(OR=3.156,P<0.05)为 NODM 发生的独立危险因素。sTG 用于预测 NODM 的 ROC 曲线下面积为 0.72。结论:肝移植受者术后 1 周血清甘油三酯逐渐恢复,到达平稳期后过高的甘油三酯会增加 NODM 发生的风险。

关键词: 肝移植术后糖尿病血脂异常高甘油三酯血症预测回归分析    
Abstract:

Objective: To investigate the postoperative serum triglyceride (TG) levels in predicting the risk of new-onset diabetes mellitus (NODM) in patients following allogeneic liver transplantation. Methods: One hundred and forty three patients undergoing allogeneic liver transplantation in Shanghai General Hospital from July 2007 to July 2014 were enrolled in this study. The NODM developed in 33 patients after liver transplantation. The curve of dynamic TG levels in the early period after liver transplantation was generated. Independent risk factors of NODM were determined by univariate and multivariant logistic regression analyses. The clinical value of TG in predicting NODM was analyzed by area under the ROC curve (AUC). Results: Serum TG levels were gradually rising in the first week and then reached the plateau phase (stable TG, sTG) in patients after surgery. The sTG in NODM group were significantly higher than that in non-NODM group (Z=–2.31, P<0.05). Glucocorticoid therapy (OR=4.054, P<0.01), FK506 drug concentration in the first week after operation (OR=3.482, P<0.05) and sTG (OR=3.156, P<0.05) were independent risk factors of NODM. ROC curve analysis showed that the AUC of sTG in predicting NODM was 0.72.Conclusion: TG shows a gradual recovery process in the early period after liver transplantation, and the higher TG level in stable phase may significantly increase the risk of NODM in patients.

Key words: New-onset diabetes mellitus after liver transplantation    Dyslipidemia    Hypertriglyceridemia    Prediction    Regression analysis
收稿日期: 2020-08-20 出版日期: 2021-06-18
CLC:  S857.13  
基金资助: 上海交通大学“医工交叉基金”(YG2019QNB36); 上海申康医院发展中心临床科技创新项目(SHDC12018X15); 上海市第一人民医院临床研究创新团队项目(CTCCR-2018BP01)
通讯作者: 卢战军     E-mail: 18121281590@189.cn;lzjdoctor@126.com
作者简介: 吴 懿,主管护师,主要从事肝胆胰外科重症护理研究;E-mail:18121281590@189.cn;https://orcid.org/0000-0002-3543-3514
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引用本文:

吴懿,蒋巍亮,杨晓军,黎文华,万荣,陆伦根,樊军卫,卢战军. 肝移植受者术后早期血清甘油三酯变化规律及其对术后糖尿病的预测价值[J]. 浙江大学学报(医学版), 2021, 50(2): 239-244.

WU Yi,JIANG Weiliang,YANG Xiaojun,LI Wenhua,WAN Rong,LU Lungen,FAN Junwei,LU Zhanjun. Postoperative serum triglyceride levels in predicting risk of new-onset diabetes mellitus in patients following liver transplantation. J Zhejiang Univ (Med Sci), 2021, 50(2): 239-244.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0114        http://www.zjujournals.com/med/CN/Y2021/V50/I2/239

图 1  143 例肝移植受者术后血清甘油三酯水平变化

影响因素

NODM 组

n=33)

非 NODM 组

n=110)

偏回归系数

标准误

P

相对危险度

(95% 可信区间)

受体年龄(岁)*

47±10

48±9

0.006

0.021

>0.05

1.006(0.965~1.049)

性别比(男/女)

11.39

3.13

0.427

0.478

>0.05

1.533(0.600~3.912)

术前丙氨酸转氨酶(U/L)*

40±58

48±65

0.002

0.003

>0.05

1.002(0.996~1.008)

术前总胆红素(μmol/L)*

54±85

99±153

0.003

0.002

>0.05

1.003(1.000~1.007)

术前总胆固醇(mmol/L)*

3.3±1.2

3.5±1.7

–0.182

0.518

>0.05

0.834(0.302~2.301)

术前甘油三酯(mmol/L)*

0.9±0.4

0.8±0.4

0.076

0.153

>0.05

1.079(0.799~1.456)

术前 MELD 评分*

14.3±1.2

11.1±0.4

0.099

0.036

<0.01

1.104(1.028~1.186)

术后激素治疗比例(%)

48.48

28.18

0.875

0.408

<0.05

2.398(1.079~5.333)

术后第 1 周他克莫司浓度(ng/mL)*

11.1±1.3

8.8±0.5

0.845

0.416

<0.05

2.327(1.029~5.263)

sTG水平(mmol/L)#

1.75(1.42,2.34)

1.53(1.27,1.86)

1.157

0.415

<0.01

3.181(1.409~7.179)

表 1  肝移植受者新发糖尿病危险因素的单因素 Logistic 回归分析结果

影响因素

偏回归系数

标准误

P

相对危险度

(95%可信区间)

术前 MELD 评分

0.068

0.044

>0.05

1.070(0.983~1.166)

术后激素治疗比例

1.400

0.517

<0.01

4.054(1.472~11.166)

术后第 1 周他克莫司浓度

1.248

0.484

<0.05

3.482(1.349~8.985)

sTG水平

1.149

0.488

<0.05

3.156(1.212~8.220)

表 2  肝移植受者新发糖尿病危险因素的多因素 Logistic 回归分析结果
图 2  肝移植受者术后平稳期甘油三酯(sTG)水平对新发糖尿病的预测价值
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