신이식후 당뇨병의 발병원인에 있어서 인슐린 분비능과 저항성의 역할

Abstract

Background : Our study was undertaken to investigate the pathogenesis and possible risk factors for post -renaltransplantation diabetes mellitus (PTDM). Methods : we recruited 114patients with normal glucoset olerance , and performed the 75g oral glucose tolerance tests (OGTT) and the short insulin tolerance tests 1week before and 9∼12 months after transplantation , respectively . Results : The subjects were classified into three group son the basis of OGTT after transplantation by WHO criteria : 1) 36 (3 1.6%) subjects with normal glucose tolerance ; 2) 51 (45 .7%) subjects with impaired glucose tolerance ; and 3) 27 (23 .7%) subjects with post-renal transplantation diabete smellitus. Dosages of steroid and cyclosporin-A (C sA) were equivalent among the 3groups . Before transplantation , the fast ingand 2-h plasmaglucose , and proinsulin / insulin (PI/ I) ratios were significantly higher in the IGT and PTDM group sthan in the NGT group , but insulin sensitivity index (ISI) was not different among 3groups. In addition, the are a under the curve (AUC ) -insulinon OGTT was significantly lower in the PTDM group than in the NGT group. After transplantation , however, ISI was increased in all groups. Furthermore, the ISI and PI/I ratios revealed significantly higher values in the PTDM group than in the NGT group after transplantation. Conclusion : These results revealed that fast in gand 2-h plasm aglucoselevels, as well asproinsulin/ insulin ratio before transplantation, which may all be in dicators of -cell dysfunction, could be the predic to rsforthe development of PTDM and -cell dysfunction rather than insulin resistance was proved to be the mainfactor for the pathogenes is o f PTDM (J Kor Diabete s Asso 485∼ 496, 2000)