CAJ | 학술논문

目的探讨自体外周血造血干细胞移植治疗1型糖尿病的有效性及安全性.方法 2009年11月至2010年8月于解放军第三○九医院细胞治疗科诊治的16例1型糖尿病患者经环磷酰胺+粒细胞集落刺激因子动员造血干细胞至外周血,血细胞分离机采集外周血造血干细胞并予以冻存;患者采用环磷酰胺+猪抗人淋巴细胞球蛋白方案预处理后,经静脉回输造血干细胞.观察所有患者移植前后胰岛素注射剂量、糖化血红蛋白(HbA1c)水平、C肽水平、血糖水平,同时记录治疗过程中的不良反应.结果自体外周血造血干细胞移植后12例患者脱离胰岛素,脱离胰岛素时间在移植后3～20 d,中位时间为9 d.中位随访28周(8～44周).12例中最长已脱离胰岛素10个月余,无患者再重新依赖胰岛素.4例患者未脱离胰岛素,此4例患者移植前均C肽水平低且病程较长,但胰岛素用量均较移植前下降,所有患者胰岛功能较前明显改善.所有患者未出现骨髓抑制等严重不良反应.结论自体外周血造血干细胞移植治疗1 型糖尿病,初步结果显示出一定的临床有效性及安全性,远期疗效有待进一步验证.
목적 탐토자체외주혈조혈간세포이식치료1형당뇨병적유효성급안전성.방법 2009년11월지2010년8월우해방군제삼○구의원세포치료과진치적16례1형당뇨병환자경배린선알+립세포집락자격인자동원조혈간세포지외주혈,혈세포분리궤채집외주혈조혈간세포병여이동존;환자채용배린선알+저항인림파세포구단백방안예처리후,경정맥회수조혈간세포.관찰소유환자이식전후이도소주사제량、당화혈홍단백(HbA1c)수평、C태수평、혈당수평,동시기록치료과정중적불량반응.결과 자체외주혈조혈간세포이식후12례환자탈리이도소,탈리이도소시간재이식후3～20 d,중위시간위9 d.중위수방28주(8～44주).12례중최장이탈리이도소10개월여,무환자재중신의뢰이도소.4례환자미탈리이도소,차4례환자이식전균C태수평저차병정교장,단이도소용량균교이식전하강,소유환자이도공능교전명현개선.소유환자미출현골수억제등엄중불량반응.결론 자체외주혈조혈간세포이식치료1 형당뇨병,초보결과현시출일정적림상유효성급안전성,원기료효유대진일보험증.
Objective To explore the efficacy and safety of autologous peripherial blood hematopoietic stem cell transplantation (APBHST) in patients with type 1 diabetes mellitus. Methods Hematopoietic stem cells were mobilized with cyclophosphamide and granulocyte colony stimulating factor for 16 patients with type 1 diabetes mellitus who admitted to our department during November 2009 to August 2010. And then stem cells were collected from peripheral blood by leukapheresis and cryopreservation. The cells were infused intravenously after conditioning with cyclophosphamide and antithymocyte globulin. To compare the daily dose of exogenous insulin requirements, the serum levels of hemoglobin A1c (HbA1c), C-peptide, islet cell function during the mixed meal tolerance test were measured before and at different times after APBHST. Blood glucose was monitored 7 times a day before and after APBHST. And the adverse effects were recorded during and after APBHST. Results The median follow-up was 28 weeks (range: 8-44 weeks). Twelve of 16 patients stayed free from insulin at 3-20 days post APBHST. And islet cell function greatly improved after APBHST. Four of 16 patients required exogenous insulin but the dosage decreased. And all 4 patients had a poor level of C-peptide before APBHSCT. There were no such severe adverse effects as myelosuppression. Conclusion Very encouraging results have been obtained in the patients treated with APBHST. There is definite therapeutic effects and safety in a short term. But further follow-up is necessary to confirm the duration of insulin independence and the mechanisms of action.