肾移植受者移植后糖尿病的影响因素及风险预测模型的建立。

Yuan Dong
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摘要

目的是探讨肾移植受者移植后糖尿病(PTDM)的影响因素,并建立风险预测模型。研究对2015年5月至2022年3月期间接受肾移植的408名患者的临床数据进行了回顾性分析。采用简单随机抽样方法,以3:1的比例将其分为训练集(n=306)和测试集(n=102)。根据 PTDM 的发生情况,训练集被进一步分为 PTDM 组和非 PTDM 组。通过最小绝对收缩和选择算子以及多变量逻辑回归分析,确定了 PTDM 的影响因素。构建并验证了一个提名图预测模型。非 PT-DM 组和 PTDM 组的术前体重指数(BMI)、糖尿病家族史、术前和餐后 2 小时血糖、术前和餐后 2 小时肽指数、术后低镁血症、他克莫司全血浓度、三酰甘油、糖化白蛋白和空腹血糖均有显著差异(P<0.05)。体重指数、糖尿病家族史、术前 2 小时和餐后血糖以及术后全血他克莫司浓度是 PTDM 的独立风险因素。相比之下,术前和餐后 2 小时的肽指数是一个独立的保护因素(P<0.05)。肾移植患者的 PTDM 发生率与糖尿病家族史、术前体重指数、餐后 2 小时血糖、餐后 2 小时肽指数和术后全血他克莫司浓度有关。
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Influencing factors of post-transplantation diabetes mellitus in kidney transplant recipients and establishment of a risk prediction model.
The aim was to explore the influencing factors of post-trans-plantation diabetes mellitus (PTDM) in kidney transplant recipients and to es-tablish a risk prediction model. A retrospective analysis was performed on the clinical data of 408 patients subjected to kidney transplantation from May 2015 to March 2022. With the simple random sampling method, they were divided into a training set (n=306) and a test set (n=102) at a ratio of 3:1. According to the occurrence of PTDM, the training set was further classified into PTDM and non-PTDM groups. The influencing factors of PTDM were identified by least absolute shrinkage and selection operator and multivariate logistic regression analysis. A nomogram prediction model was constructed and validated. Non-PT-DM and PTDM groups had significantly different preoperative body mass index (BMI), family history of diabetes mellitus, 2-h preoperative and postprandial blood glucose, 2-hpreoperative and postprandial peptide index, postoperative hypomagnesemia, whole blood concentration of tacrolimus, triacylglycerol, glycated albumin and fasting blood glucose (P<0.05). BMI, family history of diabetes mellitus, 2-h preoperative and postprandial blood glucose, and post-operative whole blood tacrolimus concentration were independent risk factors for PTDM. In contrast, the 2-h preoperative and postprandial peptide index was an independent protective factor (P<0.05). The incidence of PTDM in patients receiving kidney transplantation correlates with the family history of diabetes mellitus, preoperative BMI, 2-h postprandial blood glucose, 2-h postprandial peptide index, and postoperative whole blood tacrolimus concentration.
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