【摘要】 目的探讨肝移植术后糖尿病(PTDM)的临床特征和诊治措施。方法回顾性分析我院自2003年10月到2008年8月的58例PTDM患者的临床资料。70.7%(41/58)的患者予胰岛素治疗,激素组23例口服激素的PTDM患者中有15例激素减量或停用;FK506组16例使用单药他克莫司(FK506)免疫抑制方案的PTDM患者,转换为霉酚酸酯(MMF)或西罗莫司(RPM)为主的免疫抑制方案,随访3个月,观察改变免疫抑制方案对PTDM的影响。结果 89.7%(52/58)的PTDM患者临床症状不典型,激素组有5例患者空腹血糖正常,出现糖尿病逆转;11例患者胰岛素用量显著降低或停用,无一例发生急性排斥反应。FK506组有2例患者糖尿病逆转,10例患者胰岛素用量显著降低或停用,1例患者发生急性排斥反应,在FK506加量后排斥反应得以控制。结论肝移植术后PTDM的临床症状不典型,胰岛素治疗占主体。减低激素和FK506用量,转换MMF或RPM为主的免疫抑制方案,可能是防治PTDM的有效手段。更多还原

【Abstract】 Objective Tostudy the clinical feature and management ofpost-transplant diabetes mellitus(PTDM)following orthotopic liver transplantation(OLT).Methods The clinical data of 58 patients of PTDM in our transplant center from October 2003 to Auguest 2008 were retrospectively analyzed.The dose of steroid was decreased or withdrawn in 15 of 23 patients who used steroid as one of the immunosuppressants(the group of steroid).Sixteen patients of PTDM who used FK506 as the only immunosuppressant were conversed to MMF or sirolimus-based immunosuppression protocol(the group of FK506).The prognosis of these patients after three months were analyzed to study the relationship between the immunosuppressant and PTDM.Results Fifty-two (89.7%)patients had not the diabetic symptoms and 41(70.7%)patients were treated with insulin.In the group of steroid,5 patients had antidiabetic measures withdrawn and the diabetes mellitus had been reversed.Eleven patients had insulin decreased dramatically or withdrawn.No one had acute rejection in this group.In the group of FK506,2 patients had diabetes mellitus reversed.Ten patients had insulin decreased dramatically or withdrawn. One patient had acute rejection in this group and the rejection had been controlled after the dose of FK506 was increased.Conclusions Patients of PTDM following OLT are often asymptomatic and most of them need insulin treatment.Both of reducing the dose of steroid and FK506 and conversion to MMF or sirolimus-based immuno-suppression protocol have a significant influence of PTDM.更多还原