Plasma Malondialdehyde and Risk of New-Onset Diabetes after Transplantation in Renal Transplant Recipients: A Prospective Cohort Study.
肾移植患者移植后血浆MDA与新发糖尿病风险: 一项前瞻性队列研究。
IF：5.6880 Doi：10.3390/jcm8040453
New-onset diabetes after transplantation (NODAT) is a frequent complication in renal transplant recipients (RTR). Although oxidative stress has been associated with diabetes mellitus, data regarding NODAT are limited. We aimed to prospectively investigate the long-term association between the oxidative stress biomarker malondialdehyde (measured by high-performance liquid chromatography) and NODAT in an extensively phenotyped cohort of non-diabetic RTR with a functioning graft ≥1 year. We included 516 RTR (51 ± 13 years-old, 57% male). Median plasma malondialdehyde (MDA) was 2.55 (IQR, 1.92-3.66) µmol/L. During a median follow-up of 5.3 (IQR, 4.6-6.0) years, 56 (11%) RTR developed NODAT. In Cox proportional-hazards regression analyses, MDA was inversely associated with NODAT, independent of immunosuppressive therapy, transplant-specific covariates, lifestyle, inflammation, and metabolism parameters (HR, 0.55; 95% CI, 0.36-0.83 per 1-SD increase; p < 0.01). Dietary antioxidants intake (e.g., vitamin E, α-lipoic acid, and linoleic acid) were effect-modifiers of the association between MDA and NODAT, with particularly strong inverse associations within the subgroup of RTR with relatively higher dietary antioxidants intake. In conclusion, plasma MDA concentration is inversely and independently associated with long-term risk of NODAT in RTR. Our findings support a potential underrecognized role of oxidative stress in post-transplantation glucose homeostasis.
移植后新发糖尿病 (NODAT) 是肾移植受体 (RTR) 的常见并发症。尽管氧化应激与糖尿病有关，但关于 NODAT 的数据有限。我们的目的是前瞻性地研究氧化应激生物标记物 mda (通过高效液相色谱法测量) 之间的长期关联 NODAT 在一个功能移植物 ≥ 1 年的非糖尿病 RTR 的广泛表型队列中。我们包括 516 RTR (51 ± 13 岁，57% 男性)。血浆 MDA 中位数为 2.55 (IQR，1.92-3.66) mol/L。在 5.3 (IQR，4.6-6.0) 年的中位随访中，56 (11%) RTR 发展为 NODAT。在 Cox 比例风险回归分析中，独立于免疫抑制治疗、移植特异性协变量、生活方式、炎症和代谢参数，MDA 与 NODAT 呈负相关 (HR，0.55; 95% 每 1-sd 增加 0.36-0.83; p <0.01)。膳食抗氧化剂摄入量 (如维生素E 、 α-硫辛酸）是 MDA 和 NODAT 之间关联的效应修饰剂, RTR 亚组中具有特别强的反向关联，饮食抗氧化剂摄入量相对较高。总之，血浆 MDA 浓度与 RTR 中 NODAT 的长期风险成反比且独立相关。我们的发现支持了氧化应激在移植后葡萄糖稳态中的潜在作用。
