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中国移植后糖尿病诊疗技术规范(2019版)

中华医学会器官移植学分会

中华医学会器官移植学分会. 中国移植后糖尿病诊疗技术规范(2019版)[J]. 器官移植, 2019, 10(1): 1-9. doi: 10.3969/j.issn.1674-7445.2019.01.001
引用本文: 中华医学会器官移植学分会. 中国移植后糖尿病诊疗技术规范(2019版)[J]. 器官移植, 2019, 10(1): 1-9. doi: 10.3969/j.issn.1674-7445.2019.01.001
Branch of Organ Transplantation of Chinese Medical Association. Technical specifcation for diagnosis and treatment of post transplantation diabetes mellitus in China (2019 edition)[J]. ORGAN TRANSPLANTATION, 2019, 10(1): 1-9. doi: 10.3969/j.issn.1674-7445.2019.01.001
Citation: Branch of Organ Transplantation of Chinese Medical Association. Technical specifcation for diagnosis and treatment of post transplantation diabetes mellitus in China (2019 edition)[J]. ORGAN TRANSPLANTATION, 2019, 10(1): 1-9. doi: 10.3969/j.issn.1674-7445.2019.01.001

中国移植后糖尿病诊疗技术规范(2019版)

doi: 10.3969/j.issn.1674-7445.2019.01.001
基金项目: 

国家自然科学基金 81570680

详细信息
    通讯作者:

    石炳毅, 男, 1953 年生, 博士, 主任医师, 博士研究生导师, 研究方向为器官移植, Email:shibingyi666@126.com; 李宁, Email:SXTYLining666@126.com

  • 中图分类号: R617, R587.1

Technical specifcation for diagnosis and treatment of post transplantation diabetes mellitus in China (2019 edition)

  • 摘要: 为了进一步规范中国移植后糖尿病(PTDM)的诊断和治疗, 中华医学会器官移植学分会组织器官移植专家和糖尿病专家, 总结器官移植后血糖异常的国内外最新进展, 在《中国器官移植术后糖尿病诊疗指南(2016版)》的基础上, 结合临床实践, 从PTDM的定义和诊断标准、流行病学、危险因素和发病机制、对移植受者和移植物预后的影响、预防及治疗策略等方面, 制定PTDM诊疗技术规范(2019版)。

     

  • 表  1  ADA制定的糖尿病和糖尿病前期诊断标准

    Table  1.   Diagnostic criteria of diabetes and prediabetes by ADA

    诊断 ADA标准a
    糖尿病 糖尿病症状且RPG≥11.1 mmol/L(200 mg/dL)或FPG≥7.0 mmol/L(126 mg/L)或2HPG≥11.1 mmol/L(200 mg/dL)或HbA1c≥6.5%
    糖尿病前期病变(prediabetes)
      空腹血糖受损(IFG) FPG 5.6~6.9 mmol/L(100~124 mg/dL)
      糖耐量减低(IGT) FPG 6.1~7.0 mmol/L且2HPG 7.8~11.0 mmol/L
      高危患者 HbA1c 5.7%~6.4%
    正常糖耐量 FPG < 5.6 mmol/L(100 mg/dL)且2HPG & #60;7.8 mmol/L(140 mg/dL)且HbA1c < 5.7%
    RPG为随机血糖,指1日中不论上次进餐时间的任意时刻血糖;FPG为空腹血糖,指至少8 h无热量摄入;OGTT为口服葡萄糖耐量试验,使用75 g无水葡萄糖水溶液后口服进行;2HPG为OGTT 2 h血糖;HbA1c为糖化血红蛋白;糖尿病症状包括多尿、多饮和不明原因的体质量降低。a血糖异常次日必须复查静脉血糖以确认诊断,任何情况下都必须排除明确的急性代谢异常导致的高血糖
    下载: 导出CSV

    表  2  现有降糖药物的临床使用小结

    Table  2.   Summary of the clinical use of available hypoglycemic drugs

    制剂 作用机制 优点 缺点 肾功能不全时的剂量
    双胍类(二甲双胍) 减少肝糖输出;改善胰岛素抵抗 减轻体质量, 不增加低血糖风险;降低肥胖T2DM患者心血管事件和死亡风险;价廉 胃肠道反应;肾功能不全时乳酸酸中毒 减量:CKD 3a期
    停用:GFR < 45 mL/min
    磺脲类(格列吡嗪、格列齐特等) 促进胰岛β细胞释放胰岛素 可降低HbA1c 1%~2% 低血糖、体质量增加、肾功能不全时蓄积 减量:CKD 3期
    禁用:CKD 4~5期
    噻唑烷二酮类(罗格列酮、吡格列酮) 增加胰岛素敏感性 经肝脏代谢并不增加血糖风险 液体潴留、增加心力衰竭风险;增加骨质疏松、骨折、膀胱癌风险 无需调整:CKD 1~3a期
    慎用:CKD 3b~5期
    格列奈类(瑞格列奈1、那格列奈2) 促进早时相胰岛素分泌 吸收快、起效快、作用时间短、降低餐后血糖、不加速肾衰竭1 低血糖、体质量增加、肾衰竭时剂量调整2 无需调整1:CKD 1~5期
    无需调整2:CKD 1~3a期
    减量2:CKD 3b~4期
    慎用2:CKD 5期
    GLP-1受体激动剂(依克那肽3、利拉鲁肽4) 促进胰岛素分泌、减少胰高血糖素产生、增加饱腹感 不增加体质量(可能降低)、低血糖风险小、降血压 胃肠道反应、胰腺炎影响药物吸收、价格昂贵、肾功能损害、产生抗体 慎用3:eGFR 30~50 mL/min
    禁用3:eGFR < 30 mL/min
    禁用4:eGFR < 60 mL/min
    α糖苷酶抑制剂(阿卡波糖) 延缓胃肠道碳水化合物吸收 低血糖事件少、不增加体质量且有减轻趋势 胃肠道反应 禁用:CKD 4~5期
    DDP-4抑制剂(西格列汀5、维格列汀6、利格列汀6、沙格列汀7) 减慢肠促胰岛素失活 不增加体质量 价格昂贵、胰腺炎风险、可能致癌 禁用5:eGFR < 50 mL/min
    无需调整6
    减量7
    胰岛素 外源性降糖激素 有效减少微血管和大血管并发症, 无“封顶效应”, 剂型丰富方便个体化治疗 体质量增加、皮下给药、低血糖、可能致癌 常常需要减量
    GLP-1为胰高血糖素样肽-1;DDP-4为二肽基肽酶-4;eGFR为估算肾小球滤过率;GFR为肾小球滤过率;CKD为慢性肾脏疾病;相同的上标数字为同一药物
    下载: 导出CSV
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  • 收稿日期:  2018-11-01
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-01-15

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