肝移植术后糖尿病危险因素及其预防

王浩; 樊永强; 刘丰; 史志勇; 张瑞; 徐钧

doi:10.12449/JCH250736

肝移植术后糖尿病危险因素及其预防

DOI: 10.12449/JCH250736

王浩^{1, 2},
樊永强^{1, 2},
刘丰³,
史志勇¹,
张瑞¹,
徐钧^1, , ,

1.
山西医科大学第一医院肝胆外科及肝脏移植中心，太原 030001
2.
山西医科大学第一临床医学院，太原 030001
3.
山西省肿瘤医院，中国医学科学院肿瘤医院山西医院，山西医科大学附属肿瘤医院头颈外科，太原 031000

基金项目:

山西省重点实验室项目 (202204010931008);

山西省中央引导地方科技发展资金项目 (YDZJSX2021B012);

国家自然科学基金 (82470693);

山西省重点研发计划 (202302130501013)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：王浩负责设计论文框架，起草论文；樊永强、刘丰负责文献查找，绘制图表；史志勇、张瑞负责论文修改；徐钧负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
徐钧， junxuty@163.com （ORCID： 0000-0003-3755-9660）

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出版历程
- 收稿日期: 2024-11-19
- 录用日期: 2024-12-02
- 出版日期: 2025-07-25

Risk factors for diabetes after liver transplantation and related preventive measures

Hao WANG^{1, 2},
Yongqiang FAN^{1, 2},
Feng LIU³,
Zhiyong SHI¹,
Rui ZHANG¹,
Jun XU^{1
, ,
,}

1.
Department of Hepatobiliary Surgery and Liver Transplant Center，The First Hospital of Shanxi Medical University，Taiyuan 030001，China
2.
The First Clinical Medical College of Shanxi Medical University，Taiyuan 030001，China
3.
Department of Head and Neck Surgery，Shanxi Provincial Cancer Hospital，Shanxi Hospital Affiliated to Cancer Hospital of Chinese Academy of Medical Sciences，Cancer Hospital Affiliated to Shanxi Medical University，Taiyuan 031000，China

Research funding:

Shanxi Provincial Key Laboratory Project (202204010931008);

Shanxi Central Guidance Local Science and Technology Development Fund Project (YDZJSX2021B012);

National Natural Science Foundation of China (82470693);

Shanxi Key Research and Development Program (202302130501013)

More Information

Corresponding author: XU Jun， junxuty@163.com （ORCID： 0000-0003-3755-9660）

摘要

摘要: 近年来，肝移植受者生存期不断延长，移植术后糖尿病影响患者长期生存的严重并发症愈发受到关注。移植术后糖尿病会增加感染和心血管事件的发生风险，进而影响移植物和患者的生存率，因此识别并干预高危人群对改善患者预后至关重要。本文综述了肝移植术后糖尿病的危险因素，旨在加深对移植术后糖尿病的认识，为疾病的预防和治疗提供理论依据。
- 肝移植 /
- 终末期肝病 /
- 糖尿病 /
- 危险因素
Abstract: In recent years， as the survival time of liver transplant recipients continues to increase， serious complications after transplantation， including diabetes， which affects the long-term survival of patients， have attracted more and more attention. Diabetes after liver transplantation can increase the risk of infection and cardiovascular disease， which in turn affects the survival rate of grafts and patients， and therefore， identification and intervention for high-risk populations are of great importance for improving the prognosis of patients. This article reviews the risk factors for diabetes after liver transplantation， in order to deepen the understanding of diabetes after liver transplantation and provide a theoretical basis for disease prevention and treatment.
- Liver Transplantation /
- End Stage Liver Disease /
- Diabetes Mellitus /
- Risk Factors

HTML全文

表 1 糖尿病诊断标准（ADA）

Table 1. Diagnostic criteria for diabetes mellitus （ADA）

诊断标准	静脉血浆葡萄糖或HbA1c水平
典型糖尿病症状
随机血糖	≥11.1 mmol/L
或加上FPG	≥7.0 mmol/L
或加上2HPG	≥11.1 mmol/L
或加上HbA1c	≥6.5%
注：典型糖尿病症状包括烦渴多饮、多尿、多食、不明原因体质量下降。无糖尿病典型症状者，须改日复查确认。FPG，空腹血糖；2HPG，餐后2 h血糖；HbA1c，糖化血红蛋白。

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表 2 糖代谢状态分类（ADA）

Table 2. Classification of glucose metabolic status （ADA）

糖代谢状态	诊断标准
正常血糖	FPG<5.6 mmol/L和2HPG<7.8 mmol/L和 HbA1c<5.7%
空腹血糖受损	FPG 5.6～6.9 mmol/L
糖耐量受损	FPG<7.0 mmol/L和2HPG 7.8～11.0 mmol/L
患糖尿病风险增加	HbA1c 5.7%～6.4%

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表 3 近5年肝移植受者PTDM危险因素的主要研究

Table 3. Major studies on risk factors for PTDM in liver transplant recipients in the last 5 years

第一作者	年份	国家	病例数	发生率	危险因素
Bai R^［30］	2024	中国	468	24.6%	年龄、术前空腹血糖受损、术后FPG和住院时间
尚莹^［31］	2024	中国	293	22.5%	年龄>46岁、高血压史、术前FPG>6.1 mmol/L、术前血清低密度脂蛋白水平>3.12 mmol/L、单用环孢素/环孢素联合麦考酚酯或西罗莫司
Lee S^［25］	2024	韩国	165	33%	移植术后肌肉减少症
Fernández-Ramírez A^［32］	2024	墨西哥	152	15%	糖尿病家族史
李畅^［33］	2022	中国	364	13.3%、16.9%、 27%（1、3、5年）	年龄、免疫排斥反应、术后住院时长
Campos MB^［34］	2022	巴西	207	28%	酒精性肝硬化、HCV和泼尼松
Dascal R^［35］	2022	加拿大	905	20.3%	年龄较大、移植前BMI较高、潜在的免疫介导的肝脏疾病、TAC谷水平较低和随访时间较长
Jeddi M^［36］	2021	伊朗	397	24.2%	年龄
Gulsoy Kirnap N^［37］	2020	土耳其	238	10.1%	年龄
Liang J^［38］	2020	中国	767	35.98%	术前TG水平（仅男性患者）

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