[肾移植受者移植后新发糖尿病的危险因素:自身数据和荟萃分析]。

IF 0.3 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
M S Novikova, L O Minushkina, O N Kotenko, D A Zateyshchikov, O I Boeva, S S Allazova, E M Shilov, O M Koteshkova, M B Antsiferov
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引用次数: 0

摘要

目的:比较1989年至2018年第52市临床医院肾移植受者(RTRs)移植后新发糖尿病(NODAT)的危险因素,并对已发表的相关研究进行系统分析。材料和方法:在一项30年(1989-2018)的回顾性研究中,我们发现两组有和没有NODAT的受体在年龄、性别、多囊肾病、尸肾、环孢素、i-mTOR和类固醇方面存在统计学差异。NODAT患者年龄较大,多为男性,更有可能患有多囊肾病和已故供体肾脏,更有可能接受环孢素、i-mTOR和类固醇治疗(结果:荟萃分析共纳入13项病例对照研究。在总共849项研究中,13项纳入了系统评价和荟萃分析,包括我们的研究,共有n=6797个rtr,其中n=1305例患有NODAT, n=5492例未患有NODAT。为分析NODAT的发生率,我们记录了广泛的数据(6.5-50.7%),平均为17.9%(固定模型)或24.3%(随机模型)。在城市临床医院№52的俄罗斯登记中记录的NODAT比例较低(11.5%),然而,分析研究中的数据是高度异质性的:I2=98.14%, 95% CI:从97.61到98.55,pp=0.05), Egger检验(p=0.01)不排除在这种情况下存在发表偏倚。有关NODAT危险因素的数据异质性较小。这项荟萃分析显示,年龄、多囊肾病、i-mTOR和类固醇治疗与NODAT相关,而性别、钙调磷酸酶抑制剂的使用和尸肾无关。在任何情况下都没有选择偏差的证据。结论:肾移植受者发生NODAT的危险因素包括年龄较大、多囊肾病、i-mTOR和类固醇治疗,这些因素可引发胰岛素抵抗状态。为了降低NODAT的风险,应考虑修改免疫抑制方案的可能性,并在RTRs中使用降低胰岛素抵抗和具有肾保护作用的药物。因此,需要随机研究来评估SGLT2抑制剂在RTRs中的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Risk factors for new-onset diabetes after transplantation in kidney transplant recipients: own data and meta-analysis].

Aim: To compare risk factors for new-onset diabetes after transplantation (NODAT) among renal transplant recipients (RTRs) from 1989 to 2018 in the City Clinical Hospital №52, with a systematic analysis of published studies on this topic.

Materials and methods: In a 30-year (1989-2018) retrospective study, we found statistically significant differences in age, gender, polycystic kidney disease, cadaveric kidney, cyclosporine, i-mTOR, and steroids between two groups of recipients with and without NODAT. Patients with NODAT were older, more male, more likely to have polycystic kidney disease and deceased donor kidneys, and more likely to be treated with cyclosporine, i-mTOR, and steroids (p<0.05). We conducted a meta-analysis to evaluate the impact of these indicators on the development of NODAT. MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were searched for eligible case-control studies of risk factors for NODAT in RTRs published between 1990 and 2019. Meta-analysis of proportions was performed using the Freeman-Tukey transformation to calculate weighted summary proportions from a fixed and random effects model.

Results: A total of 13 case-control studies were included in the meta-analysis. Of the total 849 studies found, 13 were included in the systematic review and meta-analysis, including ours, with a total of n=6797 RTRs, of which n=1305 patients with NODAT and n=5492 without NODAT. A wide range of data was recorded for the analysis of the incidence of NODAT (6.5-50.7%), with an average of 17.9% (fixed model) or 24.3% (random model). The proportion of NODAT recorded in the Russian registry of the City Clinical Hospital №52 was lower (11.5%), however, the data in the analyzed studies were highly heterogeneous: I2=98.14%, 95% CI: from 97.61 to 98.55, p<0.0001, Begg's test (p=0.05) and Egger's test (p=0.01) do not exclude the presence of publication bias in this case. Data on NODAT risk factors were less heterogeneous. This meta-analysis showed that age, polycystic kidney disease, i-mTOR and steroid therapy were associated with NODAT, whereas gender, calcineurin inhibitor use, and cadaveric kidney were not. There was no evidence of selection bias in any of the cases.

Conclusion: Risk factors for NODAT in kidney transplant recipients include older age, polycystic kidney disease, i-mTOR and steroid therapy, which initiate a state of insulin resistance. To reduce the risk of NODAT, the possibility of modifying immunosuppression regimens and the use of drugs that reduce insulin resistance and have a nephroprotective effect in RTRs should be considered. Therefore, randomized studies are needed to evaluate SGLT2 inhibitor in RTRs.

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来源期刊
Terapevticheskii Arkhiv
Terapevticheskii Arkhiv 医学-医学:内科
CiteScore
1.40
自引率
33.30%
发文量
171
审稿时长
3-8 weeks
期刊介绍: Терапевтический архив The journal was founded by the prominent Russian therapists M.P. Konchalovsky and G.F. Lang in 1923. Then its editors-in-chief were Professors V.N. Vinogradov and A.G. Gukasyan. Since 1972, E.I. Chazov, Academician of the Russian Academy of Sciences, has been heading the editorial board of the journal. Over 90 years, there have been more than 1000 issues where the authors and editorial staff have done their best for readers to keep abreast of current advances in medical science and practice and for physicians to master the advanced principles of recognition and treatment of a wide spectrum of visceral diseases. The papers published in the journal (editorials, original articles, lectures, reviews, etc.) cover both current scientific achievements and practical experience in diagnosing, treating, and preventing visceral diseases. The authors of publications are not only Russian, but also foreign scientists and physicians. All papers are peer-reviewed by highly qualified Russian specialists. The journal is published monthly. Traditionally, each issue has predominantly certain thematic areas covering individual therapy specializations. Every year, one of the issues is devoted to related problems in practical medicine (allergology and immunology, neurology and psychiatry, obstetrics, oncology, etc.). This all draws the attention of the reading public to the journal. The journal is indexed in RSCI (Russian Science Citation Index), PubMed/Medline, Index Medicus, Scopus/EMBASE, Web of Science Core Collection (Science Citation Index Expanded), Web of Science (Russian Science Citation Index - RSCI, Current Contents Connect, BIOSIS Previews), Google Scholar, Ulrich''s Periodicals Directory. The journal is included in the list of periodicals recommended by the Higher Attestation Committee for publishing the papers containing the basic materials of doctoral and candidate dissertations. By the decision of the Presidium of the Russian Academy of Medical Sciences, the “Therapevticheskiy Arkhiv” was awarded the Botkin medal. It was admitted to the European Association of Sciences Editors (EASE). The journal was honored with the Golden Press Fund decoration at the 13th International Press Professional Exhibition.
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