摘要：
背景:研究显示年龄、性别、体质量指数、丙肝感染、免疫抑制药物和糖尿病家族史等是肾移植后新发糖尿病相关的危险因素, 但危险因素对肾移植后新发糖尿病的影响尚存争议.目的:荟萃分析近10年来影响肾移植后新发糖尿病可能相关的危险因素, 为肾移植后新发糖尿病的预防和控制提供参考依据.方法:检索国内外与肾移植后新发糖尿病危险因素相关研究的文献, 检索的数据库包括PubM ed、Embase、Cochrane Library、中国生物医学文献数据库 (CBMdisc), 检索时间限定为2005年1月到2018年5月, 语种限定为中文和英文.由2名评价员按照纳入和排除标准筛选文献并提取资料, 参考Newcastle-OttawaScale质量评价标准进行质量评价, 用RevM an5.3软件进行荟萃分析, 提取影响肾移植后新发糖尿病的危险因素.结果与结论:①21个研究被纳入, 纳入研究的总病例数为8 206例, 其中1 489例发生肾移植后新发糖尿病, 总发病率为18.15％;②经过荟萃分析, 共有7个因素对肾移植后新发糖尿病发病的影响有统计学意义, 其中不可干预的危险因素依次为年龄≥50岁、供肾来源;可干预的危险因素依次为:体质量指数≥25 kg/m2、急性排斥反应、使用他克莫司、丙型肝炎病毒感染、多囊肾;③不能确定是否为肾移植后新发糖尿病危险因素:糖尿病家族史;④结果提示, 年龄＞ 50岁、供肾来源、体质量指数≥25 kg/m2、急性排斥反应、使用他克莫司、丙型肝炎病毒感染、多囊肾7个因素是肾移植后新发糖尿病的危险因素, 而糖尿病家族史尚不能确定是否为肾移植后新发糖尿病的危险因素.%BACKGROUND: Age, sex, body mass index, hepatitis C infection, immunosuppressive drugs and family history of diabetes mellitus are shown to be risk factors for new-onset diabetes mellitus after kidney transplantation, but their effects remain controversial. OBJECTIVE: To systematically assess the risk factors for new-onset diabetes mellitus after kidney transplantation, so as to provide evidences for preventing and controlling the disease. METHODS: PubMed, Embase, Cochrane Library and CBMdisc databases were searched for the articles concerning risk factors for new-onset diabetes mellitus after kidney transplantation published between January 2005 and May 2018. Two researchers extracted data from each study based on inclusion and exclusion criteria. Quality assessment was conducted in accordance with New castle-Ottawa Scale standard. Meta-analysis was performed on Revman 5.3 software to identify the risk factors for new-onset diabetes mellitus after kidney transplantation. RESULTS AND CONCLUSION: (1) Twenty-one studies involving 8 206 patients were included. There were 1 489 cases of new-onset diabetes mellitus after kidney transplantation, and the morbidity was 18.15％. (2) The meta-analysis identified the following seven significant risk factors, non-modifiable risk factors: age ≥ 50 years, and donor type; modifiable risk factors: body mass index ≥ 25 kg/m2, acute rejection, tacrolimus usage, hepatitis C infection and polycystic kidney. (3) Uncertain risk factor was family history of diabetes. (4) To conclude, age, donor type, body mass index ≥ 25 kg/m2, acute rejection, tacrolimus usage, hepatitis C infection and polycystic kidney are risk factors for new-onset diabetes mellitus after kidney transplantation. But whether the family history of diabetes mellitus is the risk factor remains uncertain.
