肺移植患者移植后血糖变化轨迹的潜在类别及影响因素研究

doi:10.3761/j.issn.0254-1769.2025.12.006

摘要/Abstract

摘要： 目的探究肺移植患者移植后血糖变化轨迹的潜在类别及其影响因素，为识别移植后糖尿病高风险人群提供借鉴。方法便利选取2022年1月—2023年3月在杭州市某三级甲等综合医院住院的122例肺移植患者作为调查对象。收集患者的社会人口学及疾病相关资料，以及术前1周（T0）、术后1周（T1）、术后1个月（T2）、术后3个月（T3）、术后6个月（T4）、术后1年（T5）的空腹血糖值。采用潜变量增长混合模型识别肺移植后血糖变化轨迹的潜在类别，使用二元Logistic回归分析探究其影响因素。结果最终共纳入109例肺移植患者，识别出肺移植患者移植后血糖变化轨迹的潜在类别分为移植后糖尿病高风险（23.85%）和低风险（76.15%）。BMI、饮酒史、午后血糖和他克莫司谷浓度是肺移植患者移植后血糖变化轨迹潜在类别的影响因素（均P<0.05）。结论肺移植患者移植后血糖变化轨迹存在移植后糖尿病高风险和低风险2个潜在类别。医护人员要重视移植前超重或肥胖、有饮酒史，移植早期午后血糖过高和移植稳定期他克莫司谷浓度过高的肺疾病患者的糖尿病筛查与评估，制订全程化和个体化的血糖管理方案。

关键词: 肺移植, 移植后糖尿病, 潜在类别, 影响因素分析, 纵向研究, 护理

Abstract:

Objective To explore the latent classes and influencing factors of blood glucose trajectories after transplantation in lung transplantation patients，and provide references for identifying high-risk population of post-transplant diabetes mellitus. Methods 122 lung transplantation patients who were hospitalized in a tertiary A general hospital in Hangzhou from January 2022 to March 2023 were selected conveniently as survey subjects. Socio-demographic and disease-related data were collected，and fasting plasma glucose at 1 week before surgery （T0），1 week after surgery（T1），1 month after surgery（T2），3 months after surgery（T3），6 months after surgery （T4），1 year after surgery（T5） were collected. Growth mixture model was used to identify categories of blood glucose trajectories after lung transplantation，and binary Logistic regression analysis was used to explore the influencing factors. Results A total of 109 lung transplantation patients were enrolled in the study，and 2 latent classes of blood glucose trajectories were identified：high risk（23.85%） and low risk（76.15%） of post-transplant diabetes mellitus. BMI，drinking history，afternoon blood glucose and tacrolimus trough concentration were the influencing factors of latent classes of blood glucose trajectories after lung transplantation（all P<0.05）. Conclusion There are 2 latent classes of blood glucose trajectories after lung transplantation，namely high risk and low risk of post-transplant diabetes mellitus. Medical staff should pay attention to diabetes screening and assessment of lung transplantation patients who are overweight or obese，have a drinking history before transplantation，have high afternoon blood glucose in early stage of transplantation and have high tacrolimus trough concentration in stable stage of transplantation，so as to formulate a comprehensive and individualized blood glucose management program.

Key words: Lung Transplantation, Post-Transplant Diabetes Mellitus, Latent Class, Root Cause Analysis, Longitudinal Studies, Nursing Care

郭璐瑶, 曾妃, 兰美娟, 蔡凌云, 梁江淑渊, 顾培培, 朱岩. 肺移植患者移植后血糖变化轨迹的潜在类别及影响因素研究[J]. 中华护理杂志, 2025, 60(12): 1447-1453.

GUO Luyao, ZENG Fei, LAN Meijuan, CAI Lingyun, LIANG Jiangshuyuan, GU Peipei, ZHU Yan. A study on latent classes and influencing factors of blood glucose trajectories after transplantation in lung transplantation patients[J]. Chinese Journal of Nursing, 2025, 60(12): 1447-1453.

图/表 5

表1 肺移植患者一般资料及移植后血糖变化轨迹潜在类别的单因素分析（n=109）

Table 1 General information and univariate analysis of latent classes of blood glucose trajectories after transplantation of lung transplantation patients（n=109）

表2 肺移植患者移植后血糖变化轨迹的潜变量增长混合模型拟合结果（n=109）

Table 2 Fitting results of GMM for blood glucose trajectories after transplantation of lung transplantation patients （n=109）

图1 肺移植患者移植后血糖变化的潜在类别轨迹注：PTDM为移植后糖尿病。

Figure 1 Latent classes trajectory of blood glucose after transplant of lung transplantation patients

表3 分类变量赋值表

Table 3 Categorical variable assignment table

表4 肺移植患者移植后血糖变化轨迹潜在类别的Logistic回归分析

Table 4 Logistic regression analysis of latent classes of blood glucose trajectories after transplantation of lung transplantation patients

参考文献 19

[1]	Singh TP, Cherikh WS, Hsich E, et al. Graft survival in primary thoracic organ transplant recipients:a special report from the International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation[J]. J Heart Lung Transplant, 2023, 42(10):1321-1333.
[2]	Jenssen T, Hartmann A. Post-transplant diabetes mellitus in patients with solid organ transplants[J]. Nat Rev Endocrinol, 2019, 15(3):172-188. DOI PMID
[3]	Sharif A, Hecking M, de Vries AJ, et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus:recommendations and future directions[J]. Am J Transplant, 2014, 14(9):1992-2000. DOI PMID
[4]	Lim WH, Lok CE, Kim SJ, et al. Impact of pretransplant and new-onset diabetes after transplantation on the risk of major adverse cardiovascular events in kidney transplant recipients:a population-based cohort study[J]. Transplantation, 2021, 105(11):2470-2481.
[5]	Liu Y, Zheng JX, He QN, et al. Impact of varied immunosuppressive agents and post-transplant diabetes mellitus on prognosis among diverse transplant recipients(experimental studies)[J]. Int J Surg, 2024, 110(4):2007-2024.
[6]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[7]	中国康复医学会器官移植康复专业委员会. 成人实体器官移植后糖尿病管理专家共识[J]. 中华器官移植杂志, 2023, 44(7):396-412.
	Professional Committee of Organ Transplantation and Rehabil-itation,Chinese Association of Rehabilitation Medicine. Expert consensus on the management of diabetes after solid organ transplantation in adults[J]. Chin J Organ Transplant, 2023, 44(7):396-412.
[8]	马海平, 黄炎. 重症患者应激性高血糖的护理研究进展[J]. 上海护理, 2023, 23(5):25-29.
	Ma HP, Huang Y. Research progress on nursing care of stress hyperglycemia in critically ill patients[J]. Shanghai Nurs, 2023, 23(5):25-29.
[9]	中华医学会器官移植学分会. 中国移植后糖尿病诊疗技术规范(2019版)[J]. 器官移植, 2019, 10(1):1-9.
	Branch of Organ Transplantation of Chinese Medical Association. Diagnosis and treatment specifications technical specification for diagnosis and treatment of post transplantation diabetes mellitus in China(2019 edition)[J]. Organ Transplant, 2019, 10(1):1-9.
[10]	曾妃, 兰美娟, 梁江淑渊, 等. 肺移植患者术后肺康复护理专家共识[J]. 中华护理杂志, 2024, 59(1):10-15.
	Zeng F, Lan MJ, Liang JSY, et al. Expert consensus on postoperative pulmonary rehabilitation nursing for lung transplant patients[J]. Chin J Nurs, 2024, 59(1):10-15. DOI URL
[11]	Yu WT, Jiang HC. Paeoniflorin alleviates high glucose-induced endothelial cell apoptosis in diabetes mellitus by inhibiting HRAS-activated RAS pathway[J]. Endocr J, 2024, 71(11):1045-1053. DOI PMID
[12]	蔡凌云, 曾妃, 郭璐瑶, 等. 肺移植患者移植后糖尿病的影响因素分析及护理启示[J]. 中华护理杂志, 2024, 59(16):1987-1992. DOI URL
	Cai LY, Zeng F, Guo LY, et al. Analysis and nursing enlightenment of influencing factors of post-transplant diabetes mellitus in lung transplant recipients[J]. Chin J Nurs, 2024, 59(16):1987-1992. DOI URL
[13]	Janez A, Muzurovic E, Bogdanski P, et al. Modern management of cardiometabolic continuum:from overweight/obesity to prediabetes/type 2 diabetes mellitus. recommendations from the eastern and southern Europe diabetes and obesity expert group[J]. Diabetes Ther, 2024, 15(9):1865-1892.
[14]	Tseng PY, Sung FC, Muo CH, et al. Risk of diabetes and hypertension in a population with alcohol use disorders[J]. BMC Public Health, 2024, 24(1):868.
[15]	Yang BC, Wu SY, Leung PS. Alcohol ingestion induces pancreatic islet dysfunction and apoptosis via mediation of FGF21 resistance[J]. Ann Transl Med, 2020, 8(6):310. DOI PMID
[16]	Schwaiger E, Krenn S, Kurnikowski A, et al. Early postoperative basal insulin therapy versus standard of care for the prevention of diabetes mellitus after kidney transplantation:a multicenter randomized trial[J]. J Am Soc Nephrol, 2021, 32(8):2083-2098.
[17]	陈文倩, 张雷, 张弋, 等. 实体器官移植他克莫司个体化治疗专家共识[J]. 实用器官移植电子杂志, 2022, 10(4):301-308.
	Chen WQ, Zhang L, Zhang Y, et al. Expert consensus on individualized treatment of tacrolimus in solid organ transplantation[J]. Pract J Organ Transplant Electron Version, 2022, 10(4):301-308.
[18]	邓琼琳, 乔文博, 褚君卿, 等. 肺移植患者术后免疫抑制剂管饲给药方案的构建及初步应用[J]. 中华护理杂志, 2025, 60(7): 819-826. DOI URL
	Deng QL, Qiao WB, Chu JQ, et al. Construction and implementation of an immunosuppressant administrating via feeding tubes scheme for lung transplantations[J]. Chin J Nur, 2025, 60(7):819-826.
[19]	Rodriguez-Rodriguez AE, Porrini E, Torres A. Beta-cell dysfunction induced by tacrolimus:a way to explain type 2 diabetes?[J]. Int J Mol Sci, 2021, 22(19):10311.