同种异体胰岛细胞移植治疗1型糖尿病的护理  

Clinical Allograft Islets Post-transplant 1 Year for Type 1 Diabetes Mellitus with A Modified Edmonton Protocol

作　　者：张雯[1] 

机构地区：[1]四川省人民医院,四川成都610072

出　　处：《四川医学》2015年第7期1059-1062,共4页Sichuan Medical Journal

摘　　要：目的总结同种异体胰岛细胞移植治疗1型糖尿病的护理研究。方法按JDRF标准筛选3例1型糖尿病患者(T1DM),并实施同种异体胰岛细胞移植。在GMP实验室内以Liberase酶消化胰腺器官、COBE 2991细胞分离机分离、连续密度梯度纯化,获取高纯度与高活性的胰岛细胞。培养12h后,检测其达到移植标准,再经皮穿刺肝脏门静脉主干,经门静脉将胰岛细胞匀速移植到肝脏内。术后应用各种护理方法,密切观察病情变化和各种并发症的变化。结果2例完全脱离胰岛素治疗,1例胰岛素用量较术前减少60%以上。术后血糖稳定,C肽、糖化血红蛋白在正常范围,肾功能得以改善,无移植并发症、以及低血糖发作,患者掌握了术后自我管理的方法,总结出了个体化的护理经验。结论患者护理效果满意,初步建立同种异体胰岛细胞移植治疗1型糖尿病一整套护理方法。Objective To investigate the pancreatic islet cell isolation technology,quality standards,and allograft islet cell transplantation in the treatment of type 1 diabetes safety and effectiveness. Methods According to Juvenile Diabetes Research Foundation（ JDRF） standard screening method,three cases of type 1 diabetes（ T1DM） were selected as allograft islet cells recipients. Using Liberase enzyme digested pancreatic organs,COBE 2991 cell separator,and discontinuous density gradient purificationto obtained high purity and high activity of islet cells. All these procedures were conducted in our GMP facilities. Cultured after12 h,testing islets reached transplant standards,then performed percutaneous hepatic portal vein trunk of the recipients,islet cells were through the portal vein into the recipient liver site. After islet transplantation,using a modified Edmonton immunosuppressive protocol controlled rejection,and monitored of blood glucose,C peptide and glycate hemoglobin level changes regularly for 1-year followed-up. Results 2 cases completely out of insulin therapy,1 case compared with the preoperative insulin dosage reduction of60% or more. Postoperative blood glucose was stable,C peptide and glycosylated hemoglobin were in the normal range,as well as improved renal function. No transplant complications and hypoglycemia were observed. Conclusion Allograft islet cell transplantation and the improved Edmonton scheme in the short-term for treatment of type 1 diabetes is safety and effectiveness.

关 键 词：胰岛细胞 同种异体移植 糖尿病 护理 

分 类 号：R473.6[医药卫生—护理学]