摘要
目的 分析成人肝移植术后代谢综合征(metabolic syndrome,MS)的发病率及其危险因素。方法 回顾性分析中山市人民医院2015年1月1日至2020年8月31日期间生存期≥1年的成人肝移植患者的临床病理资料,采用logistic回归模型分析肝移植术后MS发生的风险因素并采用受试者操作特征(receiver operating characteristic,ROC)曲线评估预测肝移植术后MS发生指标的最佳临界值及其评估效能。结果 本研究共收集到符合纳入标准的患者107例,基于中华医学会糖尿病学会的MS诊断标准,肝移植术后有35例(32.7%)发生了MS,多因素logistic回归模型分析发现,受体年龄增加[OR(95%CI)=1.106(1.020,1.199),P=0.014]、术前体质量指数[OR(95%CI)=1.439(1.106,1.872),P=0.007]和术前血糖水平[OR(95%CI)=1.708(1.317,2.213),P<0.001]增高、术前有吸烟史[OR(95%CI)=5.814(1.640,20.610),P=0.006]及饮酒史[OR(95%CI)=5.390(1.454,19.984),P=0.012]增加肝移植术后MS发生的概率,这5个指标预测肝移植术后MS发生的ROC曲线下面积分别为0.666、0.669、0.769、0.682、0.612,3个连续性变量(受体年龄、术前体质量指数、血糖水平)相应的最佳临界值分别为53岁、23.1 kg/m~2、6.8 mmol/L,以上5个指标联合预测肝移植术后MS发生的ROC曲线下面积为0.903 [95%CI(0.831,0.952)],其敏感度及特异度分别为80.0%、90.3%。结论 从本研究结果看,成人肝移植术后受体MS发病率不低,对于术前高血糖及肥胖的患者需要重视其术前临床干预,同时对于高龄、术前有饮酒及吸烟史的受者术后需要重视MS的早期发现及早期干预。
Objective To analyze the prevalence and risk factors of metabolic syndrome(MS) after adult liver transplantation(LT) recipients. Methods The clinicopathologic data of patients with survival time ≥1 year underwent LT in the People’s Hospital of Zhongshan City from January 1, 2015 to August 31, 2020 were analyzed retrospectively.The logistic regression model was used to analyze the risk factors affecting MS occurrence after LT, and the receiver operating characteristic(ROC) curve was used to evaluate the optimal cutoff value of the index of predicting MS occurrence and its corresponding evaluation effect. Results A total of 107 patients who met the inclusion criteria were collected in this study. Based on the diagnostic criteria of MS of Chinese Medical Association Diabetes Association, the occurrence rate of MS after LT was 32.7%(35/107). Multivariate logistic regression analysis showed that the increased age of the recipient [OR(95%CI)=1.106(1.020, 1.199), P=0.014], preoperative increased body mass index [OR(95%CI)=1.439(1.106, 1.872), P=0.007] and blood glucose level [OR(95%CI)=1.708(1.317, 2.213), P<0.001], and with preoperative smoking history [OR(95%CI)=5.814(1.640, 20.610), P=0.006] and drinking history [OR(95%CI)=5.390(1.454, 19.984), P=0.012]increased the probability of MS after LT. The areas under the ROC curve(AUC) corresponding to these five indexes were0.666, 0.669, 0.769, 0.682, and 0.612, respectively. The corresponding optimal cutoff values of three continuous variables(recipient’s age, preoperative body mass index, and blood glucose level) were 53 years old, 23.1 kg/m~2, and 6.8mmol/L, respectively. The AUC of combination of the above five indexes in predicting occurrence of MS was 0.903[95%CI(0.831, 0.952)], and the sensitivity and specificity were 80.0% and 90.3%, respectively. Conclusions Incidence of MS after adult LT recipient is not low. For recipients with preoperative hyperglycemia, obese, elderly, histories of drinking and smoking before LT need to pay attention to the early detectio
作者
叶少炜
钱均霖
胡泽民
YE Shaowei;QIAN Junlin;HU Zemin(Guangdong Medical University,Zhanjiang,Guangdong 524002,P.R.China;Department of Hepatobiliary Surgery,People’s Hospital of Zhongshan City/Zhongshan Hospital Affiliated to Sun Yat-sen University,Zhongshan,Guangdong 528400,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2022年第10期1303-1307,共5页
Chinese Journal of Bases and Clinics In General Surgery
基金
2021年度中山市第一批社会公益与基础研究项目(项目编号:2021B1040)。
关键词
肝移植
代谢综合征
危险因素
liver transplantation
metabolic syndrome
risk factor
