美國(guó)新澤西州的Hermayer KL博士今日發(fā)表在《臨床內(nèi)分泌雜志》上的研究表明：不建議腎移植患者術(shù)后進(jìn)行強(qiáng)化血糖控制治療。

　　研究人員對(duì)接受腎移植的患者進(jìn)行了一項(xiàng)隨機(jī)對(duì)照試驗(yàn)，將104例患者隨機(jī)分配到強(qiáng)化組或?qū)φ战M，強(qiáng)化組接受靜脈胰島素治療IV（強(qiáng)化）治療，對(duì)照組接受標(biāo)準(zhǔn)皮下胰島素注射SC治療。強(qiáng)化組腎移植后3天接受強(qiáng)化IV胰島素治療[血糖（BG）為70~110mg/dl]，對(duì)照組接受SC胰島素治療(BG =70~180mg/dl)。主要觀察指標(biāo)的主要終點(diǎn)為移植物功能延遲恢復(fù)（DGF），次要終點(diǎn)為血糖控制、移植物存活和急性排斥反應(yīng)。嚴(yán)重低血糖（BG=350mg/dl）的發(fā)生率是主要安全性結(jié)果指標(biāo)。

　　研究結(jié)果顯示，104例患者中，有93例接受了腎移植：強(qiáng)化組44例，對(duì)照組49例。 強(qiáng)化治療組中8例表現(xiàn)出DGF，對(duì)照組為12例。研究共出現(xiàn)9例低血糖，其中強(qiáng)化治療組7例，對(duì)照組2例。此外，強(qiáng)化治療組有5例患者發(fā)生30次高血糖，對(duì)照組有12例患者至少有一次高血糖。共發(fā)生11例排異反應(yīng)，強(qiáng)化治療組9例，對(duì)照組2例。

　　兩個(gè)治療組中，主要終點(diǎn)DGF無(wú)統(tǒng)計(jì)學(xué)差異。考慮血糖水平、排斥反應(yīng)和移植物存活，強(qiáng)化治療組患者的排斥反應(yīng)風(fēng)險(xiǎn)較高。

　　A Randomized Controlled Trial to Evaluate the Effect of Glycemic Control on Renal Transplantation Outcomes

　　Context: Outcomes from intensive glycemic control postrenal transplant have not been studied.

　　Objective: Our objective was to observe the optimal management of hyperglycemia in patients with diabetes or impaired glucose tolerance receiving renal transplantation.

　　Design, Setting, and Patients: We conducted a randomized controlled trial with patients undergoing renal transplantation randomized to either iv insulin therapy (intensive) or standard sc insulin therapy while the patients were admitted to the hospital.

　　Interventions: The study consisted of a 3-day postrenal transplant group treated with intensive iv insulin [blood glucose (BG) = 70–110 mg/dl] or a control group treated with sc insulin (BG = 70–180 mg/dl).

　　Main Outcome Measure: The primary endpoint was delayed graft function (DGF). Secondary endpoints were glycemic control, graft survival, and acute rejection episodes.

　　Results: A total of 104 patients were screened and randomized to either the intensive or control condition; however, the intention-to-treat analysis set consisted of only the 93 participants (n = 44 intensive, n = 49 control) that underwent a renal transplant. DGF was present in 18% (eight of 44) of the intensive group and 24% (12 of 49) of the control group (P = 0.46). The occurrence of severe hypoglycemia (BG < 40 mg/dl) and severe hyperglycemia (BG > 350 mg/dl) were the primary safety outcome measures. There were nine participants with hypoglycemia identified, seven of which (78%) were in the intensive treatment group (P = 0.08). There were 30 instances of hyperglycemia with five participants (11%) in the intensive group and 12 participants (24%) in the control group having at least one hyperglycemic event (P = 0.10). For the 11 rejection episodes, nine were in the intensive treatment group (P = 0.013).

　　Conclusions: The primary outcome measure of DGF was not statistically different for the two treatment groups. Regarding longer-term rejection and graft survival, the intensively treated participants were at higher risk for a rejection episode.