一例1型糖尿病胰肾联合移植后血糖与α和β细胞分泌功能的变化

The changes of the blood sugar and the α、β cells secretion function in a type 1 diabetic patient after pancreas-kidney joint-transplantation

目的 通过１型糖尿病晚期肾病胰肾联合移植术前后血糖、Ｃ肽、胰升血糖素值的比较，了解术后α和β细胞分泌功能的恢复状况，及对糖尿病疗效的影响。方法 检测手术前后血糖、Ｃ肽和腹升血糖素，并进行比较，术后１８０天时测定胰岛素释放试验和葡萄糖耐量试验。结果 通过胰肾联合移植术前后血糖、α和β细胞分泌功能的观察发现，术前病人的Ｃ肽水平明显低于正常，胰升血糖素高于正常，尽管使用了较大量的胰岛素，血糖仍然较高。术后第１天开始Ｃ肽分泌明显增加，几乎超过正常，胰升血糖素分泌较术前几乎减少一半，３０天后降到正常；术后第７天血糖降到正常，第２０天停用胰岛素，２４０天内血糖仍然在正常范围；术后１８０天时检测葡萄糖耐量试验和胰岛素释放试验结果均正常。结论胰肾联合移植既能改善１型糖尿病肾病病人的肾功能，又能通过提高胰腺β细胞的分泌功能，达到治疗糖尿病的目的。胰肾联合移植是治疗１型糖尿病晚期肾病的最佳方法。

Objective To evaluate the recovery of α and β cells secretion function and the effects on the blood sugar after the operation. By the comparison of the blood sugar,C peptide and the glucagon levels in the late type 1 diabetic patient with nephropathy before and after pancreas-kidney joint-transplantation. Methods Measuring and comparing the blood sugar,C peptide and glucagon, so as to assess the therapeutic effect of operations. Performing the insulin releasing test and glucose tolerance test on the 180th day after operation to acquaint the recovery of diabetes and the secretion function of β cells. Results We found that before operation the patient's C peptide level was·obviously lower than normal,but the glucagon level was higher than normal. The blood sugar remained at higher level even then larger dose of insulin was applied. On the first day after operation, the C peptide secretion began to increase obviously and nearly exceeded normal level;the secretion of glucagon almost decreased to half of the preoperative level,but 30 days later,it decreased to normal; the blood sugar decreased to normal on the 7th day after operation. On the 20th day,the application of insulin were stopped, but within 240 days the blood sugar remained in normal range; 180 day after operation, the results of glucose tolerance tests and insulin releasing tests all remained normal. Conclusion The pancreas-kidney joint transplantation could improve the kidney function of the patient suffered from type 1 diabetic nephropathy,as well as treat diabetes by enhancing the secretion function of the pancreas β cell. Pancreas-kidney joint-tranplantation is the best method to cure the nephropathy of late type 1 diabetes.