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摘要: 近年来移植后糖尿病(PTDM)越来越受到人们的关注和重视。PTDM发生率较高, 多发于术后早期, 其后呈下降趋势, 该病发展具有可逆性。目前PTDM的诊断标准尚未统一, 多采用世界卫生组织和美国糖尿病协会的诊断标准。PTDM的主要术前影响因素有年龄、性别、种族和基因、肝炎病毒感染、肝硬化、糖尿病家族史、肥胖、移植前血糖等, 术后影响因素有急性排斥反应、免疫抑制剂等。针对高风险患者, 临床应予早期干预并制定个体化的血糖管理及治疗方案, 提供有针对性的健康宣传教育方案, 使肝移植患者的血糖维持在稳定的理想状态, 以有效降低PTDM的发生率, 最终得以提高患者的生存质量。
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[1] 徐晓东, 谢汝莹, 林硕, 等.肝移植术后糖代谢变化和影响因素分析[J].实用医学杂志, 2014, 30(11):1735-1738. http://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201411021.htmXu XD, Xie RY, Lin S, et al. The trend of glucose metabolism and affecting factors following liver transplantation[J].J Pract Med, 2014, 30(11):1735-1738. http://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201411021.htm [2] 陈显英, 于明香, 周俭, 等.肝移植术后三年及以上患者糖代谢异常情况及其发病机制初探[J].中华内分泌代谢杂志, 2011, 27(3):215-218. http://www.endocrmetab.com/CN/abstract/abstract554.shtmlChen XY, Yu MX, Zhou J, et al. Prevalence of abnormal glucose metabolism and preliminary investigation of its pathogenesis in patients being alive over 3 years after liver transplantation[J]. Chin J Endocrinol Metabol, 2011, 27(3):215-218. http://www.endocrmetab.com/CN/abstract/abstract554.shtml [3] Hur KY, Kim MS, Kim YS, et al. Risk factors associated with the onest and progression of post-transplantation diabetes in renal allograft recipients[J]. Diabetes Care, 2007, 30(3):609-615. doi: 10.2337/dc06-1277 [4] Martínez-Díaz-Guerra G, Guadalix S, Aramendi M, et al. Serum levels of osteocalcin and insulin resistance in patients with impaired glucose tolerance or new-onset diabetes mellitus after liver transplantation[J]. Horm Metab Res, 2016, DOI:10.1055/s-0035-1569288[Epub ahead of print]. [5] 徐晓东, 谢汝莹, 林硕, 等.肝移植术后糖尿病的可逆性预测因子分析[J].器官移植, 2014, 5(1):28-31. http://www.cnki.com.cn/Article/CJFDTOTAL-QGYZ201401008.htmXu XD, Xie RY, Lin S, et al. Analysis of predictive factors associated with the reversibility of post-transplantation diabetes mellitus[J].Organ Transplant, 2014, 5(1):28-31. http://www.cnki.com.cn/Article/CJFDTOTAL-QGYZ201401008.htm [6] American Diabetes Association. Standards of medicai care in diabetes:2010[J].Diabetes Care, 2010, 33(Suppl 1):S11-S61. http://care.diabetesjournals.org/content/diacare/33/Supplement_1/S11.full.pdf [7] American Diabetes Association. Diagnosis and classification of diabetes mellitus[J]. Diabetes care, 2014, 37(Suppl 1):S81-S90. http://care.diabetesjournals.org/content/27/suppl_1/s5 [8] Carey EJ, Aqel BA, Byrne TJ, et al. Pretransplant fasting glucose predicts new-onset diabetes after liver transplantation[J]. J Transplant, 2012:614781. https://www.ncbi.nlm.nih.gov/pubmed/22461975 [9] 闫娜娜, 姚斌, 王宇, 等.中国人群肾移植术后糖尿病危险因素的Meta分析[J/CD].中华临床医师杂志(电子版), 2013, 7(10):4395-4403. http://www.cnki.com.cn/Article/CJFDTOTAL-ZLYD201310060.htmYan NN, Yao B, Wang Y, et al. Risk factors for post renal-transplantation diabetes in Chinese:a Meta analysis[J/CD].Chin J Clin(Elect Edit), 2013, 7(10):4395-4403. http://www.cnki.com.cn/Article/CJFDTOTAL-ZLYD201310060.htm [10] 余爱荣, 范星, 辛华雯, 等.肾移植术后糖尿病发病率与危险因素[J].药物流行病学杂志, 2011, 20(4):169-172. http://www.cnki.com.cn/Article/CJFDTOTAL-YWLX201104003.htmYu AR, Fan X, Xin HW, et al. Morbidity and risk factors of post-transplantation diabetes mellitus after renal transplantation[J]. J Pharmacoepidemiol, 2011, 20(4):169-172. http://www.cnki.com.cn/Article/CJFDTOTAL-YWLX201104003.htm [11] Yates CJ, Fourlanos S, Hjelmesaeth J, et al. New-onset diabetes after kidney transplantation:changes and challenges[J]. Am J Transplant, 2012, 12(4):820-828. doi: 10.1111/j.1600-6143.2011.03855.x [12] Lim TR, Mutimer DJ. Editorial:the association of hepatitis C virus infection and post-liver transplant diabetes[J]. Aliment Pharmacol Ther, 2015, 41(5):488. doi: 10.1111/apt.2015.41.issue-5 [13] Waters DD, Ho JE, Boekholdt SM, et al. Cardiovascular event reduction versus new-onset diabetes during atorvastatin therapy:effect of baseline risk factors for diabetes[J]. J Am Coll Cardiol, 2013, 61(2):148-152. doi: 10.1016/j.jacc.2012.09.042 [14] 昝双江, 朱立勤, 段文越, 等.种族对移植患者他克莫司药动学的影响[J].中国药房, 2013, 24(26):2438-2441. http://www.cnki.com.cn/Article/CJFDTOTAL-ZGYA201326018.htmZan SJ, Zhu LQ, Duan WY, et al. Effects of race on the pharmacokinetics of tacrolimus in transplant recipients[J]. Chin Pharmacy, 2013, 24(26):2438-2441. http://www.cnki.com.cn/Article/CJFDTOTAL-ZGYA201326018.htm [15] 罗儒超, 聂新民, 李伟芳, 等. CYP3A5和多重耐药基因1多态性对肾移植患者他克莫司药代动力学参数的影响[J].国际检验医学杂志, 2010, 31(6):546-548. http://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ201006014.htmLuo RC, Lie XM, Li WF, et al. The Influence of CYP3A5 and R1(ABCB1)polymorphisms on the pharmacokinetics of tacrolimus in renal transplant recipients[J].Int J Lab Med, 2010, 31(6):546-548. http://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ201006014.htm [16] 王一西, 谢志红, 叶丽卡, 等.中国汉族、维吾尔族和哈萨克族人MDR1-C3435T基因多态性研究[J].热带医学杂志, 2013, 13(6):737-740. http://en.cnki.com.cn/Article_en/CJFDTOTAL-RDYZ201306023.htmWang YX, Xie ZH, Ye LK, et al. Genotyping study of MDR1-C3435T in healthy Han, Uygur and Kazakh Chinese[J].J Trop Med, 2013, 13(6):737-740. http://en.cnki.com.cn/Article_en/CJFDTOTAL-RDYZ201306023.htm [17] 余爱荣, 范星, 刘慧明, 等. TCF7L2基因多态性与肾移植后糖尿病的相关性[J].肾脏病与透析肾移植杂志, 2013, 22(2):125-129. http://en.cnki.com.cn/Article_en/CJFDTOTAL-SZBY201302008.htmYu AR, Fan X, Liu HM, et al. Association of TCF7L2 gene polymorphisms with posttransplantation diabetes mellitus in Chinese renal allograft recipients[J]. Chin J Nephrol Dial Transplant, 2013, 22(2):125-129. http://en.cnki.com.cn/Article_en/CJFDTOTAL-SZBY201302008.htm [18] 余爱荣, 范星, 刘慧明, 等.SLC30A8基因多态性与肾移植后糖尿病的相关性[J].中国组织工程研究, 2013, 17(31):5613-5619. http://en.cnki.com.cn/Article_en/CJFDTOTAL-SZBY201302008.htmYu AR, Fan X, Liu HM, et al. Association between SLC30A8 gene polymorphisms and diabetes mellitus after renal transplantation[J]. Chin J Tissue Eng Res, 2013, 17(31):5613-5619. http://en.cnki.com.cn/Article_en/CJFDTOTAL-SZBY201302008.htm [19] Mehta SH, Brancati FL, Sulkowski MS, et al. Prevalence of type 2 diabetes mellitus among persons with hepatitis C virus infection in the United States[J]. Ann Intern Med, 2000, 133(8):592-599. doi: 10.7326/0003-4819-133-8-200010170-00009 [20] Yadav AD, Chang YH, Aqel BA, et al. New onset diabetes mellitus in living donor versus deceased donor liver transplant recipients:analysis of the UNOS/OPTN database[J]. J Transplant, 2013:269096. https://www.ncbi.nlm.nih.gov/pubmed/24205434 [21] Huang JF, Yu ML, Dai CY, et al. Glucose abnormalities in hepatitis C virus infection[J]. Kaohsiung J Med Sci, 2013, 29(2):61-68. doi: 10.1016/j.kjms.2012.11.001 [22] 康姚洁, 王煊.丙型肝炎病毒感染致糖代谢异常的相关机制研究进展[J].实用肝脏病杂志, 2014, 17(1):102-105. http://www.wenkuxiazai.com/doc/2c462b57844769eae009edf5.htmlKang YJ, Wang X. Progress in mechanisms of abnormal glucose metabolism in patients with hepatitis C virus infection[J].J Clin Hepatol, 2014, 17(1):102-105. http://www.wenkuxiazai.com/doc/2c462b57844769eae009edf5.html [23] Miyajima I, Kawaguchi T, Fukami A, et al. Chronic HCV infection was associated with severe insulin resistance and mild atherosclerosis:a population-based study in an HCV hyperendemic area[J]. J Gastroenterol, 2013, 48(1):93-100. doi: 10.1007/s00535-012-0610-3 [24] 黄普, 何明, 高晓辉, 等.不同类型肝硬化与糖尿病发病关系研究[J].基层医学论坛, 2004, 8(9):820-821. http://www.cnki.com.cn/Article/CJFDTOTAL-YXLT200409038.htmHuang P, He M, Gao XH, et al. Study on the relationship between different types of liver cirrhosis and diabetes[J].Public Med Forum, 2004, 8(9):820-821. http://www.cnki.com.cn/Article/CJFDTOTAL-YXLT200409038.htm [25] 刘薇.肝硬化合并糖尿病74例临床分析[J].中国实用医刊, 2012, 39(13):99-100. http://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zyyk201213052Liu W. Clinical analysis of 74 cases with liver cirrhosis complicated with diabetes mellitus[J].Chin J Pract Med, 2012, 39(13)::99-100. http://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zyyk201213052 [26] Fernández Castillo R, Fernandez Gallegos R, Gomez Urquiza JL, et al. Study and prevalence of post-transplant diabetes mellitus; analysis on a group of kidney transplant recipients[J]. Nutr Hosp, 2014, 30(4):813-817. https://www.ncbi.nlm.nih.gov/pubmed/25335667 [27] 王琼.乙型肝炎后肝硬化患者血清总胆汁酸测定的临床价值[J].检验医学与临床, 2012, 9(17):2181-2182. http://www.cnki.com.cn/Article/CJFDTOTAL-JYYL201217039.htmWang Q. Clinical value of serum total bile acid in patients with cirrhosis after hepatitis B[J].Lab Med Clin, 2012, 9(17):2181-2182. http://www.cnki.com.cn/Article/CJFDTOTAL-JYYL201217039.htm [28] Bjørnholt JV, Erikssen G, Liestøl K, et al. Type 2 diabetes and maternal family history:an impact beyond slow glucose removal rate and fasting hyperglycemia in low-risk individuals? results from 22.5 years of follow-up of healthy nondiabetic men[J]. Diabetes care, 2000, 23(9):1255-1259. doi: 10.2337/diacare.23.9.1255 [29] 王婧懿, 刘林. 352例有糖尿病家族史的健康体检者EZSCAN检测结果分析[J].中国疗养医学, 2013, 22(12):1061-1063. http://www.cnki.com.cn/Article/CJFDTotal-ZGLX201312004.htmWang JY, Liu L. Analysis of EZSCAN test 352 cases with diabetes family history of health examination results[J].Chin J Conval Med, 2013, 22(12):1061-1063. http://www.cnki.com.cn/Article/CJFDTotal-ZGLX201312004.htm [30] 李佳芮, 刘博伟, 刘俊茹, 等.血清铁蛋白对有2型糖尿病家族史一级亲属糖代谢的影响[J].中华内分泌代谢杂志, 2013, 29(8):688-690. http://www.endocrmetab.com/CN/abstract/abstract1357.shtmlLi JR, Liu BW, Liu JR, et al. Influence of serum ferritin on glucose metabolism in first degree relatives with family history of type 2 diabetes mellitus[J].Chin J Endocrinol Metabol, 2013, 29(8):688-690. http://www.endocrmetab.com/CN/abstract/abstract1357.shtml [31] Shah T, Kasravi A, Huang E, et al. Risk factors for development of new-onset diabetes mellitus after kidney transplantation[J]. Transplantation, 2006, 82(12):1673-1676. doi: 10.1097/01.tp.0000250756.66348.9a [32] 洪天配, 魏蕊.关注肥胖与糖尿病相关性及其潜在机制[J].中华医学杂志, 2013, 93(36):2849-2850. http://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zhyx201336001Hong TP, Wei R.To focus on the relationship between obesity and diabetes and its underlying mechanism[J].Nat Med J Chin, 2013, 93(36):2849-2850. http://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zhyx201336001 [33] 杨曦东.代谢综合征与2型糖尿病慢性并发症的相关性分析[J].中国医药指南, 2014, 12(10):130-131. http://www.cnki.com.cn/Article/CJFDTOTAL-YYXK201410095.htmYang XD. Correlation between metabolic syndrome and chronic complications of type 2 diabetes mellitus[J].Guide Chin Med, 2014, 12(10):130-131. http://www.cnki.com.cn/Article/CJFDTOTAL-YYXK201410095.htm [34] 刘丽, 逄增昌, 汪韶洁, 等.家族史与肥胖对2型糖尿病协同作用[J].中国公共卫生, 2012, 28(3):305-306. http://www.oalib.com/paper/4502401Liu L, Feng ZC, Wang SJ, et al. Synergistic effect of diabetes family history and obesity on incidence of type 2 diabetes[J].Chin J Pub Health, 2012, 28(3):305-306. http://www.oalib.com/paper/4502401 [35] Lankarani KB, Eshraghian A, Nikeghbalian S, et al. New onset diabetes and impaired fasting glucose after liver transplant:risk analysis and the impact of tacrolimus dose[J]. Exp Clin Transplant, 2014, 12(1):46-51. doi: 10.6002/ect [36] 王英吉, 狄文佳, 孙勤, 等.肾移植术后糖尿病相关危险因素[J].肾脏病与透析肾移植杂志, 2015, 24(1):21-25. http://www.cnki.com.cn/Article/CJFDTotal-SZBY201501005.htmWang YJ, Di WJ, Sun Q, et al. Post-transplantation diabetes mellitus and the risk factors[J]. Chin J Nephrol Dial Transplant, 2015, 24(1):21-25. http://www.cnki.com.cn/Article/CJFDTotal-SZBY201501005.htm [37] 巫林伟, 何晓顺, 邰强, 等.激素最小化免疫抑制方案在肝移植术后的应用[J].中华外科杂志, 2010, 48(7):492-495. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhwk201007004Wu LW, He XS, Tai Q, et al. Application of steroids minimization immunosuppressive regimen in liver transplantation[J].Chin J Surg, 2010, 48(7):492-495. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhwk201007004 [38] 史瑞, 沈中阳.肝脏移植中糖皮质激素的应用[J/CD].实用器官移植电子杂志, 2014, 2(4):206-211. http://www.docin.com/p-1335996820.htmlShi R, Shen ZY. Application of glucocorticoids in liver transplantation[J/CD].Pract J Organ Transplant(Elect Vers), 2014, 2(4):206-211. http://www.docin.com/p-1335996820.html [39] 宋沧桑, 张阳, 李兴德, 等.他克莫司与环孢素肝移植术后疗效对比的Meta分析[J].临床合理用药杂志, 2015, 8(2):20-23. http://www.cnki.com.cn/Article/CJFDTotal-PLHY201502012.htmSong CS, Zhang Y, Li XD, et al. A Meta-analysis of therapeutic effect of cyclosporin versus tacrolimus after liver transplantation[J]. Chin J Clin Ration Drug Use, 2015, 8(2):20-23. http://www.cnki.com.cn/Article/CJFDTotal-PLHY201502012.htm [40] First MR, Dhadda S, Croy R, et al. New-onset diabetes after transplantation (NODAT):an evaluation of definitions in clinical trials[J]. Transplantation, 2013, 96(1):58-64. doi: 10.1097/TP.0b013e318293fcf8 [41] 李智涛, 黄汉飞, 曾仲, 等. FK506, CsA致移植后糖尿病机制的异同及应对策略[J].世界华人消化杂志, 2014, 22(8):1093-1100. doi: 10.11569/wcjd.v22.i8.1093Li ZT, Huang HF, Zeng Z, et al. Pathogenesis and management of FK506-and CsA-induced post-transplant diabetes mellitus:similarities and differences[J].Word Chin J Dig, 2014, 22(8):1093-1100. doi: 10.11569/wcjd.v22.i8.1093
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