CAJ | 학술논문

目的基于前期研究,进一步探讨自体外周造血干细胞移植(AHST)治疗1型糖尿病(T1DM)的有效性与安全性.方法环磷酰胺(CY)、粒细胞集落刺激因子动员造血干细胞至外周血,经白细胞分离术分离、处理造血干细胞并予以冻存;采用CY+兔抗胸腺细胞球蛋白预处理后,经静脉或脾动脉插管回输入体内.观察移植前后胰岛素剂量、糖化血红蛋白(HbA1c)、胰岛功能、胰岛自身抗体等变化;记录治疗期及随访期不良反应.结果 8例患者回输干细胞后:(1)3例患者在不同时期内停用胰岛素;5例患者胰岛素用量较前减少.(2)HbA1c较移植前显著降低(P<0.05);C肽较移植前不同程度地增加.(3)移植前阳性胰岛自身抗体均转阴.(4)1例患者于移植后6月出现原发性甲减;所有患者均未发生出血性膀胱炎、重度感染等严重不良反应.结论 AHST可不同程度地恢复T1DM患者的胰岛功能,改善其血糖控制,减轻其对外源性胰岛素的依赖性.但是该技术是否能作为常规方法应用于临床,仍待深入研究.
목적 기우전기연구,진일보탐토자체외주조혈간세포이식(AHST)치료1형당뇨병(T1DM)적유효성여안전성.방법 배린선알(CY)、립세포집락자격인자동원조혈간세포지외주혈,경백세포분리술분리、처리조혈간세포병여이동존;채용CY+토항흉선세포구단백예처리후,경정맥혹비동맥삽관회수입체내.관찰이식전후이도소제량、당화혈홍단백(HbA1c)、이도공능、이도자신항체등변화;기록치료기급수방기불량반응.결과 8례환자회수간세포후:(1)3례환자재불동시기내정용이도소;5례환자이도소용량교전감소.(2)HbA1c교이식전현저강저(P<0.05);C태교이식전불동정도지증가.(3)이식전양성이도자신항체균전음.(4)1례환자우이식후6월출현원발성갑감;소유환자균미발생출혈성방광염、중도감염등엄중불량반응.결론 AHST가불동정도지회복T1DM환자적이도공능,개선기혈당공제,감경기대외원성이도소적의뢰성.단시해기술시부능작위상규방법응용우림상,잉대심입연구.
Objective To further determine the safety and therapeutic effects of autologous hematopoietic stem cell transplantation (HSCT) in newly diagnosed type 1 diabetes（T1DM）by enlarging sample size and following up. MethodsHematopoietic stem cells were mobilized with cyclophosphamide and granulocyte colonystimulating factor and then collected from peripheral blood by leukapheresis and cryopreserved.The cells were infused intravenously or by splenic arterial cannula after conditioning with cyclophosphamide and rabbit antithymocyte globulin. The daily exogenous insulin requirements， serum levels of hemoglobin A1c， islet β-cell function and anti-islet antibody titers were compared between pre-HSCT and different times following HSCT. The adverse effects during and after AHST were recorded. Results3 patients became insulin free for different periods. At 3， 6 and 12 months after AHST， mean levels of hemoglobin A1c were significantly lower（P<0.05）and mean levels of C-peptide were higher than before treatment. The above four islet antibodies became negative in all patients during different time after AHST. Hypothyroidism was diagnosed in one patient 6 months after AHST.There were no severe adverse effects such as myelosuppression and hemorrhagic cystitis. Conclusions After AHST， beta cell function is increased and blood glucose control is improved in all patients. But additional studies should be performed to confirm whether AHST can be routinely conducted in clinic.