CAJ | 학술논문

背景：最近研究表明，使用大剂量正规的胰岛素治疗控制血糖水平，仍有50%的患者会出现血管、眼神经及肾脏的并发症。而作者在利用异基因造血干细胞移植治疗白血病过程中发现患者合并的糖尿病症状消失，这是否提示异基因造血干细胞移植可以作为治疗糖尿病的有效方法呢？ 　　目的：探讨造血干细胞移植治疗糖尿病的可能性。 　　方法：回顾分析既往做过的异基因造血干细胞移植的血液病患者，其中合并糖尿病4例。4例患者基础疾病分别为急性淋巴细胞白血病、慢性粒细胞白血病、再生障碍性贫血及骨髓增生异常综合征。异基因造血干细胞移植预处理方案均为环磷酰胺/全身照射，移植物抗宿主病预防均采用环孢菌素A+短程氨甲喋呤，移植前口服降糖药物或注射胰岛素进行血糖控制。 　　结果与结论：4例患者均造血恢复，移植物证据检测为供者植入，在移植后4-6个月患者血糖均恢复了正常(脱离降糖药物及胰岛素治疗)，1例患者1年后死于白血病复发，其余3例患者随访至今血糖稳定。
배경：최근연구표명，사용대제량정규적이도소치료공제혈당수평，잉유50%적환자회출현혈관、안신경급신장적병발증。이작자재이용이기인조혈간세포이식치료백혈병과정중발현환자합병적당뇨병증상소실，저시부제시이기인조혈간세포이식가이작위치료당뇨병적유효방법니？ 　　목적：탐토조혈간세포이식치료당뇨병적가능성。 　　방법：회고분석기왕주과적이기인조혈간세포이식적혈액병환자，기중합병당뇨병4례。4례환자기출질병분별위급성림파세포백혈병、만성립세포백혈병、재생장애성빈혈급골수증생이상종합정。이기인조혈간세포이식예처리방안균위배린선알/전신조사，이식물항숙주병예방균채용배포균소A+단정안갑첩령，이식전구복강당약물혹주사이도소진행혈당공제。 　　결과여결론：4례환자균조혈회복，이식물증거검측위공자식입，재이식후4-6개월환자혈당균회복료정상(탈리강당약물급이도소치료)，1례환자1년후사우백혈병복발，기여3례환자수방지금혈당은정。
BACKGROUND:Recent studies have shown that the large-dose regular insulin therapy used to control blood glucose levels can cause 50%of patients suffering from vascular, optic nerve and kidney complications. Previous results from authors exhibit that when al ogeneic hematopoietic stem celltransplantation is applied for treatment of leukemia, diabetic symptoms in patients disappear. Dose it prompt that al ogeneic hematopoietic stem celltransplantation is an effective therapy for treatment of diabetes mel itus? OBJECTIVE:To explore the feasibility of hematopoietic stem celltransplantation for treatment of diabetes mel itus. METHODS:A retrospective analysis was done regarding the data of patients with hematological diseases complicated with diabetes mel itus who underwent al ogenetic hematopoietic stem celltransplantation. Four patients with acute lymphocyte leukemia, chronic myelogenous leukemia, aplastic anemia, and myolodysplastic syndromes, respectively, were complicated with diabetes mel itus. Conditioning regimen was cyclophosphamide+total body irradiation protocol. Cyclosporin A and short-term methotrexate were used for graft-versus-host disease prophylaxis. Blood glucose was control ed by oral hypoglycemic drugs or insulin injections before transplantation. RESULTS AND CONCLUSION:Al the four patients were successful y engrafted. Fasting glucose level of the four patients recovered at 4-6 months after hematopoietic stem celltransplantation (without hypoglycemic drugs). One patient died of leukemia relapse after 12 months of hematopoietic stem celltransplantation. The other three patients had disease-free survival until the time of fol ow-up.