肾移植后糖尿病酮症酸中毒18例

背景：随着免疫抑制剂的应用，肾移植受者的内分泌和糖类、脂类代谢也发生了变化，肾移植后糖尿病酮症已成为影响患者移植后短期及长期存活率的一项严重并发症，直接影响到人肾存活。 目的：分析肾移植后糖尿病酮症酸中毒发病的相关因素，总结肾移植后糖尿病酮症酸中毒的救治方法，降低死亡率。 方法：回顾性分析2003/2009郑州人民医院肾移植科收治的18例肾移植后糖尿病酮症酸中毒患者的临床资料，既往肾移植前有糖尿病病史者2例，均为2型糖尿病；无糖尿病病史者16例。酮症发生的时间为肾移植后3 d~2.5年。早期临床表现为倦怠乏力、肌肉酸痛、发热等。随着病情的发展很快出现脱水和神经系统症状及体征。对症给予小剂量胰岛素，补液，纠正电解质酸碱平衡失调，去除诱因以及针对并发症等治疗。 结果与结论：治疗成功13例，人/肾存活良好，成功率72%；3例死亡，1例死于感染性休克，2例死于多器官功能衰竭，病死率17%；2例患者救治成功，但移植肾功能丧失，恢复血液透析。提示肾移植后糖尿病酮症酸中毒是与抗排斥药物及移植肾功能密切相关的严重的肾移植后并发症，临床表现不典型，处理不当易致严重后果，需引起临床足够重视。

Diabetic ketoacidosis in 18 cases following renal transplantation

BACKGROUND:With application of immunosuppressants, endocrine, saccharide and lipid metabolism change in recipients after renal transplantation. Diabetic ketoacidosis has become a serious complication that affects short- and long-term survival rate, directly affect transplant outcomes after renal transplantation.   OBJECTIVE:To analyze the relative onset factors of diabetic ketoacidosis after renal transplantation, and to summarize the cure methods in order to decrease death rate. METHODS:Clinical data of 18 cases with diabetic ketoacidosis after renal transplantation from 2003 to 2009 were retrospective analyzed, including 2 cases with type 2 diabetes history, and 16 cases without diabetes history. The ketosis occurred from 3 days to 2.5 years after transplantation, with early clinical manifestation of fatigue, anorexa, muscular soreness or fever. Dehydration and neurological symptoms appeared with development of pathogenetic condition. Treatments, such as small-dose insulin medication and fluid infusion, were used to correct disturbances of electrolyte and acid-base. The inducement was removed. RESULTS AND CONCLUSION:Thirteen cases were cured, with 72% success ratio. Three cases died, 1 for septic shock and 2 for multiple organ failure, with 17% case fatality rate. Two cases were successful rescued, but lost the function of transplant kidney and returned to hemodialysis. The findings demonstrated that, diabetic ketoacidosis is a complication that closely associates with anti-rejection drugs and transplanted kidney functions after transplantation. The clinical manifestation of diabetic ketoacidosis is untypical, but it leads to serious consequence if treated inappropriate, accordingly, it should be attracted great attention.