1型糖尿病患者在自体造血干细胞移植和传统胰岛素注射治疗后的动态血糖监测比较

Comparison of blood glucose after autologous hematopoietic stem cell transplantation and insulin therapy in patients with type 1 diabetes by continuous glucose monitoring system

目的对初发的新诊断1型自身免疫性糖尿病(T1D)患者分别实施自体外周造血干细胞移植(AHSCT)和传统胰岛素注射治疗,应用动态血糖监测系统评估两种治疗方式治疗的T1D患者的日内和日间血糖波动幅度的差异情况。方法对符合入选条件的初发T1D患者充分给予相关治疗方式的知情选择权,获得知情同意的患者采用AHSCT治疗(AHSCT组,22例),未获得知情同意的患者接受常规胰岛素注射治疗(常规胰岛素组,22例)。两组患者均定期收集C肽曲线下面积(AUCC)、糖化血红蛋白(HbA1c)、日胰岛素用量等指标,并应用动态血糖监测系统获取平均血糖水平(MBG)及血糖标准差(SDBG)、最大血糖波动幅度(LAGE)、平均血糖波动幅度(MAGE)、日间平均血糖绝对差(MODD)、低血糖指数(LBGI)、血糖时间百分率等指标,对血糖波动幅度进行评估。结果两组间治疗前的HbA1c、AUCC及各血糖波动参数的差异均无统计学意义(P值均>0.05)。治疗24个月后,两组患者的HbA1c水平均下降,但两组间的差异无统计学意义(P>0.05);AHSCT组的AUCC、MBG、SDBG、MODD、MAGE均显著优于常规胰岛素组(P值分别<0.01、0.05);两组间LAGE、LBGI的差异均无统计学意义(P值均>0.05)。AHSCT组的日胰岛素用量显著少于常规胰岛素组(P<0.01)。AHSCT组血糖<11.1mmol/L的时间在24h中所占百分率显著低于常规胰岛素组(P<0.05),血糖为3.9～11.1mmol/L的时间在24h中所占百分率显著高于常规胰岛素组(P<0.05);两组间血糖<3.9mmol/L的时间在24h中所占百分率的差异无统计学意义(P>0.05)。结论与传统胰岛素注射疗法相比,AHSCT能有效控制T1D患者的血糖水平,减少胰岛素用量,并可避免血糖的大幅波动。

Objective To compare blood gJucose levels between patients with type 1A diabetes treated with autologous hematopoietic stem cell transplantation （AHSCT） or insulin therapy by continuous glucose monitoring system （CGMS）. Methods Patients with newly-diagnosed type IA diabetes were divided into AHSOT group （n= 22） and insulin group （n = 22）. C-peptide area under curve （AUCC）, glycosylated hemoglobin （HbA1c） and daily dose of insulin were recorded. CGMS was used to measure mean blood glucose （MBG）, standard deviation of blood glucose （SDBG）, largest amplitude of glycemic excursions （LAGE）, mean amplitude of glycemic excursions （MAGE）, mean of daily difference （MODD）, low blood glucose index （LBGI） and the percentage of time at hyperglycaemia at each follow-up visit. Results There were no significant differences in HbA c, AUCC or blood glucose fluctuation coefficient （BGFO） levels between two groups before treatment （all P〉0.05）. The level of HbA1 c was significantly decreased 24 months after treatment in all patients, but HbA1 c, LAGE and LBGI were not significantly different between groups （all P〉0.05） ; AUCC, MBG, SDBG, MODD andMAGE in the AHSCT group were significantly superior to that in the insulin group （P〉0.01, and 0.05）. Daily dose of insulin in the AHSCT group was significantly less than that in the insulin group （P〈0.01）. The percentage of time at hyperglycaemia （blood glucose 〉11.1 mmol/L） in the AHSCT group was significanlty lower than that in the insulin group （P〈0.05）. The percentage of time of blood glucose between 3.9 and 11.1 mmol/L in the AHSCT group was significanlty higher than that in the insulin group （P〈0.05）. There was no statistical difference in hypoglycemia （blood glucoseS3.9 mmol/L） between the two groups （P〉0.05）. Conclusion AHSCT can significantly improve glucose control and reduce dosage of insulin and overall glucose excursions as compared with insulin therapy.