成人胰岛移植治疗2型糖尿病三例  

Clinical islet transplantation for type 2 diabetes mellitus： 3 cases report

作　　者：刘永锋[1] 程颖[1] 孟一曼[1] 石蕊[1] 刘树荣[1] 李桂臣[1] 吴刚[1] 陈旭春[1] 杨蕾[1] 李弘[1] 苏洪英[2] 夏永辉[2] 

机构地区：[1]中国医科大学附属第一医院普通外科教研室器官移植科,沈阳110001 [2]中国医科大学附属第一医院放射科,沈阳110001

出　　处：《中华器官移植杂志》2011年第3期156-158,共3页Chinese Journal of Organ Transplantation

基　　金：教育部高等学校博士学科点专项科研基金（20092104110006）;卫生部公益性行业科研专项基金（201002004）

摘　　要：目的探讨成人胰岛移植治疗2型糖尿病的安全性与有效性。方法为3例合并慢性肾功能衰竭的2型糖尿病患者共施行4次胰岛移植，其中2例接受成人胰岛细胞和肾联合移植（每例的胰岛细胞和肾脏来自同一供者，以下简称“联合移植”），1例为肾移植术后5个月连续2次接受胰岛细胞移植，2次胰岛细胞移植间隔9d。3例移植前均依赖胰岛素治疗，用量为0．5～0．7IU·kg^-1·d^-1。采用经皮肝门静脉穿刺，胰岛悬液重力输注，将移植胰岛注入到受者的肝脏内。2例联合移植者以巴利昔单抗诱导，术后采用低剂量他克莫司＋西罗莫司维持治疗；1例肾移植术后胰岛移植者采用环孢素A＋吗替麦考酚酯维持治疗。术后观察胰岛素使用情况，监测血糖、C-肽与糖化血红蛋白水平。结果第1例联合移植者术后第3天血糖正常，停用外源性胰岛素，但术后1个月时患者的血糖逐渐升高，遂给予少量胰岛素，与术前相比，胰岛素减量2／3。第2例联合移植者术后24h血糖即恢复正常，停用外源性胰岛素，术后第5天死于肝穿刺部位出血及继发感染。肾移植术后胰岛移植的患者在第1次胰岛移植后胰岛素用量即减少1／2，第2次胰岛移植后完全停用胰岛素。与术前相比，长期存活的2例受者术后空腹C-肽和餐后2hC-肽值平均升高600pmol／L。联合移植者术后糖化血红蛋白波动于6．7％～7．3％，肾移植后胰岛移植受者的糖化血红蛋白波动于5．5％～5．9％。结论成人胰岛移植可有效治疗达到胰岛素依赖期的2型糖尿病。Objective To evaluate the effect of islet transplantation for patients with type 2 diabetes mellitus （DM）. Methods Since December 2007, 4 cases of islet transplantations were performed on 3 patients with type 2 DM and end-stage renal disease （ESRD）. Two patients received simultaneous islet-kidney transplant from single-donor （SIK）, and one received 2 consecutive islet transplants 5 months following kidney transplantion （IAK）. All recipients given insulin with a dose of 0. 5- 0. 7 IU· kg^-1 · day^-1 before operation. The islets were transplanted into the liver through percutaneous transhepatic portal catheterization. Anti-CD25 monoclonal antibody was used as induction. For SIK, low-doses of Tacrolimus and sirolimus were used as maintenance immunosuppression protocol. For IAK, the maintenance protocol included cyclosporine and MMF. Insulin dose, the level of blood glucose, C-peptide and the value of HbA1 were observed. Results The first patient of SIKhad normal glucose level 3 days after surgery and became insulin independent within the first month, but insulin was administered gradually and the dose reduced to 1/3. The second patient of SIK died of bleeding and secondary infection of liver puncture site 5 days following operation, the blood glucose level recovered to normal 24 h after operation. The insulin dose of the patient of IAK was reduced to 1/2 after the first transplant. The patient became insulin free after the second operation. The level of fasting and postprandial C-peptide of the surviving recipients increased by 600 pmol/L. The value of HbA1 of the SIK was 6. 7%- 7. 3 %, while that of the IAK was 5.5 %- 5.9 %. Conclusion Islet transplantation is an effective treatment for patients with type 2 DM.

关 键 词：糖尿病 2型 胰岛移植 肾移植 

分 类 号：R587.1[医药卫生—内分泌]