中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2011年
3期
156-158
,共3页
刘永锋%程颖%孟一曼%石蕊%刘树荣%李桂臣%吴刚%陈旭春%杨蕾%李弘%苏洪英%夏永辉
劉永鋒%程穎%孟一曼%石蕊%劉樹榮%李桂臣%吳剛%陳旭春%楊蕾%李弘%囌洪英%夏永輝
류영봉%정영%맹일만%석예%류수영%리계신%오강%진욱춘%양뢰%리홍%소홍영%하영휘
糖尿病,2型%胰岛移植%肾移植
糖尿病,2型%胰島移植%腎移植
당뇨병,2형%이도이식%신이식
Diabetes mellitus,type 2%Islets transplantation%Kidney transplantation
目的 探讨成人胰岛移植治疗2型糖尿病的安全性与有效性.方法 为3例合并慢性肾功能衰竭的2型糖尿病患者共施行4次胰岛移植,其中2例接受成人胰岛细胞和肾联合移植(每例的胰岛细胞和肾脏来自同一供者,以下简称"联合移植"),1例为肾移植术后5个月连续2次接受胰岛细胞移植,2次胰岛细胞移植间隔9 d.3例移植前均依赖胰岛素治疗,用量为0.5～0.7IU·kg-1·d-1.采用经皮肝门静脉穿刺,胰岛悬液重力输注,将移植胰岛注入到受者的肝脏内.2例联合移植者以巴利昔单抗诱导,术后采用低剂量他克莫司+西罗莫司维持治疗;1例肾移植术后胰岛移植者采用环孢素A+吗替麦考酚酯维持治疗.术后观察胰岛素使用情况,监测血糖、C-肽与糖化血红蛋白水平.结果 第1例联合移植者术后第3天血糖正常,停用外源性胰岛素,但术后1个月时患者的血糖逐渐升高,遂给予少量胰岛素,与术前相比,胰岛素减量2/3.第2例联合移植者术后24 h血糖即恢复正常,停用外源性胰岛素,术后第5天死于肝穿刺部位出血及继发感染.肾移植术后胰岛移植的患者在第1次胰岛移植后胰岛素用量即减少1/2,第2次胰岛移植后完全停用胰岛素.与术前相比,长期存活的2例受者术后空腹C-肽和餐后2 h C-肽值平均升高600 pmol/L.联合移植者术后糖化血红蛋白波动于6.7%～7.3%,肾移植后胰岛移植受者的糖化血红蛋白波动于5.5%～5.9%.结论 成人胰岛移植可有效治疗达到胰岛素依赖期的2型糖尿病.
目的 探討成人胰島移植治療2型糖尿病的安全性與有效性.方法 為3例閤併慢性腎功能衰竭的2型糖尿病患者共施行4次胰島移植,其中2例接受成人胰島細胞和腎聯閤移植(每例的胰島細胞和腎髒來自同一供者,以下簡稱"聯閤移植"),1例為腎移植術後5箇月連續2次接受胰島細胞移植,2次胰島細胞移植間隔9 d.3例移植前均依賴胰島素治療,用量為0.5～0.7IU·kg-1·d-1.採用經皮肝門靜脈穿刺,胰島懸液重力輸註,將移植胰島註入到受者的肝髒內.2例聯閤移植者以巴利昔單抗誘導,術後採用低劑量他剋莫司+西囉莫司維持治療;1例腎移植術後胰島移植者採用環孢素A+嗎替麥攷酚酯維持治療.術後觀察胰島素使用情況,鑑測血糖、C-肽與糖化血紅蛋白水平.結果 第1例聯閤移植者術後第3天血糖正常,停用外源性胰島素,但術後1箇月時患者的血糖逐漸升高,遂給予少量胰島素,與術前相比,胰島素減量2/3.第2例聯閤移植者術後24 h血糖即恢複正常,停用外源性胰島素,術後第5天死于肝穿刺部位齣血及繼髮感染.腎移植術後胰島移植的患者在第1次胰島移植後胰島素用量即減少1/2,第2次胰島移植後完全停用胰島素.與術前相比,長期存活的2例受者術後空腹C-肽和餐後2 h C-肽值平均升高600 pmol/L.聯閤移植者術後糖化血紅蛋白波動于6.7%～7.3%,腎移植後胰島移植受者的糖化血紅蛋白波動于5.5%～5.9%.結論 成人胰島移植可有效治療達到胰島素依賴期的2型糖尿病.
목적 탐토성인이도이식치료2형당뇨병적안전성여유효성.방법 위3례합병만성신공능쇠갈적2형당뇨병환자공시행4차이도이식,기중2례접수성인이도세포화신연합이식(매례적이도세포화신장래자동일공자,이하간칭"연합이식"),1례위신이식술후5개월련속2차접수이도세포이식,2차이도세포이식간격9 d.3례이식전균의뢰이도소치료,용량위0.5～0.7IU·kg-1·d-1.채용경피간문정맥천자,이도현액중력수주,장이식이도주입도수자적간장내.2례연합이식자이파리석단항유도,술후채용저제량타극막사+서라막사유지치료;1례신이식술후이도이식자채용배포소A+마체맥고분지유지치료.술후관찰이도소사용정황,감측혈당、C-태여당화혈홍단백수평.결과 제1례연합이식자술후제3천혈당정상,정용외원성이도소,단술후1개월시환자적혈당축점승고,수급여소량이도소,여술전상비,이도소감량2/3.제2례연합이식자술후24 h혈당즉회복정상,정용외원성이도소,술후제5천사우간천자부위출혈급계발감염.신이식술후이도이식적환자재제1차이도이식후이도소용량즉감소1/2,제2차이도이식후완전정용이도소.여술전상비,장기존활적2례수자술후공복C-태화찬후2 h C-태치평균승고600 pmol/L.연합이식자술후당화혈홍단백파동우6.7%～7.3%,신이식후이도이식수자적당화혈홍단백파동우5.5%～5.9%.결론 성인이도이식가유효치료체도이도소의뢰기적2형당뇨병.
Objective To evaluate the effect of islet transplantation for patients with type 2diabetes mellitus (DM). Methods Since December 2007, 4 cases of islet transplantations were performed on 3 patients with type 2 DM and end-stage renal disease (ESRD). Two patients received simultaneous islet-kidney transplant from single-donor (SIK), and one received 2 consecutive islet transplants 5 months following kidney transplantion (IAK). All recipients given insulin with a dose of percutaneous transhepatic portal catheterization. Anti-CD25 monoclonal antibody was used as induction. For SIK, low-doses of Tacrolimus and sirolimus were used as maintenance immunosuppression protocol. For IAK, the maintenance protocol included cyclosporine and MMF.Insulin dose, the level of blood glucose, C-peptide and the value of HbA1 were observed. Results The first patient of SIKhad normal glucose level 3 days after surgery and became insulin independent within the first month, but insulin was administered gradually and the dose reduced to 1/3. The second patient of SIK died of bleeding and secondary infection of liver puncture site 5 days following operation, the blood glucose level recovered to normal 24 h after operation. The insulin dose of the patient of IAK was reduced to 1/2 after the first transplant. The patient became insulin free after the second operation. The level of fasting and postprandial C-peptide of the surviving recipients increased by 600 pmol/L. The value of HbA1 of the SIK was 6.7 %～7.3 %, while that of the IAK was 5. 5 %～ 5. 9 %. Conclusion Islet transplantation is an effective treatment for patients with type 2 DM.
