采用Edmonton免疫抑制方案的同种异体胰岛移植治疗糖尿病32例的临床研究

Clinical study of 32 cases of diabetes treated by islet allotransplantation with edmonton immunosuppression scheme

目的研究同种异体胰岛移植治疗1型糖尿病与肾移植后糖尿病的临床效果。方法对27位(其中5位行二次移植术)1型糖尿病患者或糖尿病肾病肾移植后患者施行同种异体胰岛移植。胰腺供体来自于公民死亡捐献,经消化、纯化后获得纯度≥50%、活力≥80%的胰岛,重悬于CMRL1066液体后,采用经皮肝门静脉穿刺,将胰岛悬液重力输注与肝内。术前采用巴利昔单抗诱导,术后采用口服他克莫司+吗替麦考酚酯诱导免疫耐受。定期检测移植受者血糖、C肽和糖化血红蛋白水平等指标。结果移植后平均随访7.6个月。随访期内,其中16例完全停用胰岛素,9例胰岛素用量减少50%~90%,2例效果不明显,术后C肽无显著增加。25例有效移植受者空腹血糖从移植前的(8.8±13.7)mmol/L降至(5.1±4.3)mmol/L,控制更加平稳;糖化血红蛋白A1从(7.63±4.53)%降至(5.30±1.43)%。平均C肽增量为1.34nmol/L。常见并发症为术后短暂的恶心、呕吐和转氨酶上升,无严重并发症发生。结论经肝门静脉胰岛移植是治疗1型糖尿病与肾移植后糖尿病的有效手段,短期临床疗效较好,远期疗效尚需进一步观察。

Objective To study the clinical effect of islet allotransplantation in the treatment of type 1 diabetes mellitus and post-renal transplantation diabetes mellitus. Methods Twenty-seven patients(Five of them underwent secondary transplantation) with type 1 diabetes mellitus or diabetic nephropathy underwent islet allotransplantation after kidney transplantation. Pancreatic donors came from death donations of citizens. After digestion and purification, islets with purity(≥ 50%) and vitality(≥ 80%) were obtained. After suspended in CMRL1066, the suspension of islets was gravitatively transfused into the liver by percutaneous hepatic portal vein puncture. Baliximab was used to induce immune tolerance before operation and tacrolimus + mofetil mycophenolate ester was used to induce immune tolerance after operation. The blood sugar, C-peptide and glycosylated hemoglobin levels of transplant recipients were measured regularly. Results The average followup time was 7.6 months.During the follow-up period, insulin was completely discontinued in 16 cases, reduced by 50%-90% in 9 cases, and the effect was not obvious in 2 cases, and no significant increase in C-peptide was observed. The fasting blood glucose of 25 effective transplant recipients decreased from(8.8±13.7) mmol/L to(5.1±4.3) mmol/L before transplantation, and the control was more stable.The glycosylated hemoglobin A1 decreased from(7.63±4.53)% to(5.30±1.43)%. The average increment of C-peptide was 1.34 nmol/L. The common complications were short-term nausea, vomiting and elevated aminotransferase, and no serious complications occurred. Conclusion Hepatic portal vein islet transplantation is an effective method for the treatment of type 1 diabetes mellitus and post-renal transplantation diabetes mellitus. The short-term clinical effect is better, and the long-term effect needs further observation.