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目的:探讨免疫抑制药对肾移植患者术后发生移植后糖尿病(PTDM)的影响。方法:回顾性调查496例使用环孢素(CsA组)和他克莫司(FK506组)的肾移植患者,分析其血糖变化和PTDM发病情况,并比较PTDM患者(PTDM组)和非PTDM患者(对照组)环孢素和他克莫司剂量、血浓度差异。结果:CsA组和FK506组PTDM发病率分别为23.0%(69/300)和28.9%(28/98),差异无统计学意义(P=0.280),但FK506组患者术后3,6,12个月的空腹血糖均明显高于CsA组(P<0.05)。PTDM组患者术后第1,3,6,12,24个月的环孢素剂量和术后第1,3,6个月的环孢素血浓度均明显高于对照组(P<0.05)。两组患者的他克莫司剂量和血浓度均无明显差异(P>0.05)。结论:肾移植患者术后服用大剂量环孢素和他克莫司是导致移植后糖尿病发生的重要因素。
Objective: To investigate the effect of immunosuppressive drugs on post-transplant diabetic patients (PTDM) after renal transplantation. Methods: A retrospective study of 496 renal transplant recipients with cyclosporine (CsA) and tacrolimus (FK506) was conducted to investigate the changes in blood glucose and the incidence of PTDM. PTDM patients and non-PTDM patients were compared (Control group) cyclosporine and tacrolimus dose, blood concentration differences. Results: The incidence of PTDM in CsA group and FK506 group was 23.0% (69/300) and 28.9% (28/98) respectively, with no significant difference (P = 0.280). However, the incidences of PTDM in CsA group and FK506 group were 3,6,12 The fasting blood glucose in all months was significantly higher than that in CsA group (P <0.05). The cyclosporine dose and the cyclosporine concentrations at 1, 3 and 6 months after operation in PTDM group were significantly higher than those in control group (P <0.05) . Tacrolimus dose and blood concentration in both groups had no significant difference (P> 0.05). CONCLUSIONS: Large doses of cyclosporine and tacrolimus in renal transplant recipients are important factors in the development of post-transplant diabetes mellitus.