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

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