肝移植术后糖尿病的诊治策略

doi:10.3877/cma.j.issn.1674-0793.2010.05.017

中华普通外科学文献(电子版) ›› 2010, Vol. 04 ›› Issue (05) : 461 -464. doi: 10.3877/cma.j.issn.1674-0793.2010.05.017

所属专题：文献；

论著

肝移植术后糖尿病的诊治策略

安玉玲¹, 蔡常洁¹^,^†(

), 包维民², 易慧敏¹, 陆敏强¹, 陈规划¹

^1. 510630　广州，中山大学附属第三医院肝移植中心
^2. 昆明医学院附属第二医院肝胆外科

收稿日期:2009-12-23 出版日期:2010-10-01
通信作者: 蔡常洁
基金资助:
广东省科技计划项目重大专项(2007A032000001); 中山大学5010计划项目(2007025); 广东省自然博士后启动基金(2005300717)

Management of diabetes mellitus following orthotopic liver transplantation

Yu-ling AN¹, Changjie CAI¹^,^†(), Wei-min BAO², Hui-min YI¹, Min-qiang Lu¹, Gui-hua CHEN¹

^1. Department of Transplant Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China

Received:2009-12-23 Published:2010-10-01
Corresponding author: Changjie CAI
About author:
Corresponding author: CAI Chang-jie, Email:changjiecai@hotmail.com

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目的

探讨肝移植术后糖尿病（PTDM）的临床特征和诊治措施。

方法

回顾性分析我院自2003年10月到2008年8月的58例PTDM患者的临床资料。70.7%（41/58）的患者予胰岛素治疗，激素组23例口服激素的PTDM患者中有15例激素减量或停用；FK506组16例使用单药他克莫司（FK506）免疫抑制方案的PTDM患者，转换为霉酚酸酯（MMF）或西罗莫司（RPM）为主的免疫抑制方案，随访3个月，观察改变免疫抑制方案对PTDM的影响。

结果

89.7%（52/58）的PTDM患者临床症状不典型，激素组有5例患者空腹血糖正常，出现糖尿病逆转；11例患者胰岛素用量显著降低或停用，无一例发生急性排斥反应。FK506组有2例患者糖尿病逆转，10例患者胰岛素用量显著降低或停用，1例患者发生急性排斥反应，在FK506加量后排斥反应得以控制。

结论

肝移植术后PTDM的临床症状不典型，胰岛素治疗占主体。减低激素和FK506用量，转换MMF或RPM为主的免疫抑制方案，可能是防治PTDM的有效手段。

关键词: 肝移植, 糖尿病, 免疫抑制剂, 治疗

Objective

To study the clinical feature and management of post-transplant diabetes mellitus(PTDM) following orthotopic liver transplantation (OLT).

Methods

The clinical data of 58 patients of PTDM in our transplant center from October 2003 to Auguest 2008 were retrospectively analyzed. The dose of steroid was decreased or withdrawn in 15 of 23 patients who used steroid as one of the immunosuppressants(the group of steroid). Sixteen patients of PTDM who used FK506 as the only immunosuppressant were conversed to MMF or sirolimus-based immunosuppression protocol(the group of FK506). The prognosis of these patients after three months were analyzed to study the relationship between the immunosuppressant and PTDM.

Results

Fifty-two(89.7%) patients had not the diabetic symptoms and 41(70.7%) patients were treated with insulin. In the group of steroid, 5 patients had antidiabetic measures withdrawn and the diabetes mellitus had been reversed. Eleven patients had insulin decreased dramatically or withdrawn. No one had acute rejection in this group. In the group of FK506, 2 patients had diabetes mellitus reversed. Ten patients had insulin decreased dramatically or withdrawn. One patient had acute rejection in this group and the rejection had been controlled after the dose of FK506 was increased.

Conclusions

Patients of PTDM following OLT are often asymptomatic and most of them need insulin treatment. Both of reducing the dose of steroid and FK506 and conversion to MMF or sirolimus-based immunosuppression protocol have a significant influence of PTDM.

Key words: Liver transplantation, Diabetes mellitus, Immunosuppressive agents, Management

表1 激素组治疗前后临床资料比较（n=15,±s）

项目	治疗前	治疗3个月后	P值
WBC(×10⁹/L)	6.69±1.64	6.79±1.62	0.76
SCr(μmol/L)	68.19±15.60	70.14±12.66	0.35
激素用量(mg/d)	6.67 ±1.95	2.67 ±1.95	0.000^*
胰岛素用量(11例，U/d）	19.45±8.20	9.18±9.39	0.000^*

表1 激素组治疗前后临床资料比较（n=15,±s）

项目	治疗前	治疗3个月后	P值
WBC(×10⁹/L)	6.69±1.64	6.79±1.62	0.76
SCr(μmol/L)	68.19±15.60	70.14±12.66	0.35
激素用量(mg/d)	6.67 ±1.95	2.67 ±1.95	0.000^*
胰岛素用量(11例，U/d）	19.45±8.20	9.18±9.39	0.000^*

表2 FK506组治疗前后临床资料比较（n=16,±s）

	转换前	转换3个月后	P值
WBC(×10⁹/L)	7.26±1.61	5.92 ±1.85	0.04^*
SCr(μmol/L)	94.81±20.41	89.44±15.22	0.048^*
FK506浓度	8.19±1.58	4.18±2.57	0.001 ^*
胰岛素用量(10例，U/d）	29.3±17.0	18.1±16.9	0.001 ^*

表2 FK506组治疗前后临床资料比较（n=16,±s）

	转换前	转换3个月后	P值
WBC(×10⁹/L)	7.26±1.61	5.92 ±1.85	0.04^*
SCr(μmol/L)	94.81±20.41	89.44±15.22	0.048^*
FK506浓度	8.19±1.58	4.18±2.57	0.001 ^*
胰岛素用量(10例，U/d）	29.3±17.0	18.1±16.9	0.001 ^*

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