成人胰岛细胞移植临床研究  

Single Center Experience of 20 Adult Islets Transplantation

作　　者：谭建明[1] 杨顺良[1] 蔡锦全[1] 吴卫真[1] 郭君其[1] 黄良浒[1] 王庆华[1] 吴志贤[1] 陈津[1] 

机构地区：[1]南京军区福州总医院

出　　处：《医学研究杂志》2007年第9期20-23,共4页Journal of Medical Research

基　　金：国家自然科学基金(30571759);全军"十五"重大课题(04Z007);全军"十一五"计划课题(06G037);福建省科技厅重大攻关课题(2002Y007)

摘　　要：目的建立新型成人胰岛细胞分离纯化方法，观察成人胰岛细胞移植的安全性与有效性。方法PFC与UW液双层冷藏胰腺，Liberase酶消化，COBE 2991型专用胰岛细胞分离机分离及连续密度梯度纯化，获取高纯度与高活性的胰岛细胞。采用外科方法，将短期培养的胰岛细胞经门静脉移植到肝脏内。术后监测血糖与胰岛素用量、C肽与糖化血红蛋白水平以及肝肾功能，并与术前比较。结果42个胰腺成功分离胰岛细胞，平均数量28．5万IEQ、纯度95．7％、活率93．2％、刺激指数2．43，病原学结果均阴性。11例1型糖尿病患者实施成人胰岛细胞移植20次，每次移植平均胰岛数量为11200 IEQ／kg。采用无激素免疫抑制治疗。随访7个月～4年，7例完全撤除胰岛素，4例胰岛素用量较术前减少60％以上。术后血糖稳定维持在正常水平，C肽均超过0．5nmol／L，糖化血红蛋白基本正常，肝肾功能稳定维持正常，无胰岛移植并发症。结论新型成人胰岛细胞分离纯化方法可靠，成人胰岛细胞移植治疗1型糖尿病临床疗效较好，手术简捷，安全性好。Objective To establish a new technique isolating pancreatic islet of langerhans and evaluate the clinical efficacy and safety of adult islet transplantation. Methods Pancreases were stored using the ＂2 - layer method＂ of the oxygenated perfluorochemical （PFC） and UW solution. The Pancreases were digested by Liberase collagenase enzyme and purified using continuous gradients of Ficoll - diatrizoic acid on a refrigerated COBE 2991 centrifuge to separate the islets. Cultured islets were infused by surgical approach to the liver via portal vasculature. Clinical metabolic data such as blood glucose, close of insulin, C - peptide, HbAlc, liver function and renal function, was determined and compared with the pre - transplant data. Results Islets of langerhans were isolated successfully in 42 pancreases. The average of islet yield was 285000 islet equivalents（IEQ）. Islet purity and viability were 95.7% , 93.2% , respectively. The stimulation index（SI） as assessing function of human islet was 2.43 and negative - etiology in vivo. Twenty clinical islet transplant infusions have been carried out in 11 subjects with type 1 diabetes mellitus（T1DM）. The average islet mass for infusion was 11200 IEQ/kg. The treatment strategies for islet transplantation was glucocorticoid - free immunosuppressive regimen. During 7 months to 4 years follow - up, 7 recipients had insulin independence, the dosage of insulin decreased by 60% in 4 patients after islet transplantation. The level of blood glucose and HbAlc, liver and renal function were normalized throughout follow - up period. All patients had C - peptide positive after islet transplantation. No adverse effects and complications related to islet infusion procedure. Conclusions New technique has proved to be suitable for isolating pancreatic islet of langerhans. Adult islet transplantation can be used as an effective and safe way for treating T1DM.

关 键 词：糖尿病 成人胰岛细胞移植 

分 类 号：R587.1[医药卫生—内分泌]