通过生存分析对糖尿病和非糖尿病脏移植患者之间的移植和整体生存率进行比较研究
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Paola García-Padilla1,2, Valentina Dávila-Rúales1, Diana C Hurtado1,2
1Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.
Canadian journal of kidney health and disease
|September 18, 2023
概括
由于糖尿病 (ESKD-DM) 导致末期脏疾病的患者在脏移植后的整体存活率比非糖尿病患者低. 然而,这两个组的移植存活率仍然相似,这凸显了糖尿病移植患者控制心血管风险因素的重要性.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 移植免疫学 移植免疫学
- 糖尿病学 糖尿病学
背景情况:
- 糖尿病 (DM) 是末期病 (ESKD) 的重要危险因素.
- 从历史上看,由于DM而患有ESKD的患者,与非糖尿病ESKD患者相比,在移植 (KT) 后表现较差.
- 最近的证据表明,这种生存差距可能会缩小,需要更新的比较分析.
研究的目的:
- 为了比较长期结果,特别是整体和移植存活率,由于DM而患有ESKD的移植接受者与非糖尿病病因ESKD的接受者.
- 确定影响这些不同患者队伍在移植后长达10年的生存时间的因素.
主要方法:
- 375名脏移植接受者的回顾性队列生存分析 (2004-2022年).
- 在ESKD-DM (n=60) 和ESKD-non-DM (n=315) 组之间比较整体和死亡审查的移植存活率.
- 统计分析包括日志等级测试,考克斯比例危险模型和竞争风险分析.
主要成果:
- 在ESKD-DM组,5年 (75.0%对90.8%) 和10年 (55.0%对86.7%) 的整体存活率显着较低,心血管死亡的发病率更高 (27.3%对8.2%).
- 死亡审查的移植存活率在两组之间没有显著差异 (96.7%对比93.3%在5年).
- 多变量分析确定了DM (HR=2.11),接受者年龄,延迟移植功能和供体年龄作为与整体存活相关的重要因素. 糖尿病与心血管死亡率 (SHR=6.06) 特别相关.
结论:
- 接受移植的ESKD-DM患者的整体存活率降低,主要是由于心血管死亡率增加,可能与年龄较大和先前存在的并发症有关.
- 然而,糖尿病患者和非糖尿病患者的移植存活率仍然相似,这表明移植在保护移植功能方面的有效性.
- 密切监测和积极管理心血管风险因素对于改善糖尿病移植患者的长期结果至关重要.
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