异体间充质干细胞移植治疗酮症起病1型糖尿病的临床疗效  

Clinical efficacy of allogenic mesenchymal stem cells transplantation in patients with ketosis-onset type 1 diabetes mellitus

作　　者：贾晓蕾[1] 沈山梅[1] 李莉蓉[1] 惠慧[1] 徐千越 朱大龙[1] 

机构地区：[1]南京大学医学院附属鼓楼医院内分泌科,210008

出　　处：《中华糖尿病杂志》2015年第7期425-430,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金（810706361;江苏省医学重点专科项目（XK201105）

摘　　要：目的初步观察异体间充质干细胞（MSCs）移植对以酮症起病的初发1型糖尿病（T1DM）的疗效并探讨移植时病程对疗效的影响。方法筛选2009年1月至2012年1月于南京大学医学院附属鼓楼医院内分泌科就诊的以酮症起病的初发T1DM患者10例进行异体MSCs移植，其中4例行骨髓MSCs移植，6例行脐带MSCs移植。纵向观察患者胰岛素用量、糖化血红蛋白（HbA1c）、C肽的变化。按移植时病程不同将移植患者分为病程≤1个月组（4例）和病程〉1个月组（6例）并作进一步分析。采用方差分析比较移植后不同周期各指标的变化，分层及协方差分析比较移植时病程对移植疗效的影响，生存分析比较胰岛功能衰竭速度。结果与移植前比较，移植后不同周期时10例T1DM患者平均胰岛素用量及HbA1c水平不同程度地降低，其中HbA1c于6、12个月时降低显著（7．2％±2．1％、7．2％±1．7％比10．3％±3．5％，F=4．435，P〈0．05）；空腹C肽（FC—P）及餐后2hC肽（2hC—P）较移植前无明显变化；移植后不同周期时，病程≤1个月组患者胰岛素用量的减少（6、12个月时）及2hC．P的增加（6个月时）均显著高于病程〉1个月组患者[（-0．40±0．64）比（0．08＋0．23）U·kg-1·d-1、（-0．50±0．46）比（0．08±0．17）U·kg-1·d-1和（191±258）比（-244±276）pmol／L，F=7．94、16．21、8．69，均P〈0．05]；移植后各周期时，病程≤1个月组患者胰岛功能衰竭速度低于病程〉1个月组患者（x2=3．74，P=0．05）。结论异体MSCs移植能够改善酮症起病初发T1DM患者的糖代谢水平，减少胰岛素用量；移植时的病程可能是移植疗效的重要影响因素。Objective To observe the efficacy of mesenchymal stem cells （MSCs） transplantation in newly diagnosed patients with ketosis-onset type 1 diabetes mellitus（T1DM）, and further evaluate the effects of diabetes duration on the efficacy of MSCs transplantation. Methods From January 2009 to January 2012, 10 newly diagnosed patients with ketosis-onset T1DM were enrolled in our study and underwent MSCs transplantation in Department of Endocrinology in Drum Tower Hospital Affiliated to Nanjing University Medical School. Of those patients, 4 cases underwent bone marrow MSCs transplantation and 6 cases underwent umbilical cord MSCs transplantation. The insulin dosage, glycated hemoglobin A1c （HbA1c） and C-peptide levels in those patients were recorded before/after MSCs transplantation. We divided all patients according to diabetes duration （duration ~〈1 month （n=4） and duration〉l month （n=6）） for further analysis. The difference in the recorded values among different time points was determined by one-way ANOVA. The effects of diabetes duration on the efficacy were analyzed by the analysis of stratification and eovariance. The survival rate of islet function after transplantation was estimated by survival analysis. Results After the transplantation, the insulin dosage and HbA,o decreased in different degree, and HbA1c reduced significantly after 6 and 12 months （7.2%±2.1%, 7.2%± 1.7% vs 10.3%±3.5%, F=4.435, P〈0.05）.However, there was no significant improvement in fasting C-peptide （FC-P） and postprandial 2 h C-peptide （2h C-P） levels. Compared with the patients with diabetes duration〉 1 month, the reduction of insulin dosage was significantly higher after 6 and 12 month （（-0.40±0.64） vs （0,08＋0.23） U kg-1 d-1, （-0.50±0.46） vs （0.08±0.17） U kg-1 d-1, F=7.94,16.21, both P〈0.05） and the increase of 2 h C-P levels was significantly higher after 6 month（（191 ± 258） vs （-244 ± 276） pmol/L, F=8.69,P〈0.05） in the patients with diabetes duration

关 键 词：糖尿病 1型 酮症起病 间充质干细胞 移植 

分 类 号：R587.1[医药卫生—内分泌]