同种异体胰岛细胞移植在成人1型糖尿病中的应用  

Allogeneic islet cell transplantation for adult type 1 diabetes mellitus

作　　者：陈焕伟[1] 栾晓军[2] 刘成洋 肖平[3] 陈劲松[2] 王晓洲[2] 邓斐文[1] 刘颖 陈国强[4] Chen Huanwei;Luan Xiaojun;Liu Chengyang;Xiao Ping;Chen Jinsong;Wang Xiaozhou;Deng Feiwen;Liu Ying;Chen Guoqiang(Department of Pancreatic Surgery,Foshan First People's Hospital,Foshan 528000,China;Department of Endocrinology,Foshan First People's Hospital,Foshan 528000,China;Clinical Research Institute,Foshan First People's Hospital,Foshan 528000,China;Department of Rheumatology and Immunology,Foshan First People's Hospital,Foshan 528000,China)

机构地区：[1]广东省佛山市第一人民医院胰腺外科,528000 [2]广东省佛山市第一人民医院内分泌,528000 [3]广东省佛山市第一人民医院临床研究所,528000 [4]广东省佛山市第一人民医院风湿免疫科,528000

出　　处：《中华肝脏外科手术学电子杂志》2020年第5期457-461,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨同种异体胰岛细胞移植治疗成人1型糖尿病的疗效及安全性。方法回顾性分析2018年12月佛山市第一人民医院行同种异体胰岛细胞移植术的1例1型糖尿病受者临床资料。供受者和(或)家属均签署知情同意书,符合医学伦理学规定。受者男,54岁。供者男,37岁,心脏死亡器官捐献,器官捐赠时血糖水平正常。供受者ABO血型相同,人类白细胞抗原 (HLA)配型良好,群体反应性抗体(PRA)为阴性,热缺血时间5 min,冷缺血时间210 min。采用标准的腹部多器官联合快速切取技术获取胰腺,在胰岛分离实验室分离纯化获得的胰岛细胞,移植培养基中培养24 h,胰岛细胞质量、数量及内毒素监测合格后在数字减影血管造影(DSA)下通过彩超引导经皮经肝门静脉穿刺置管将胰岛细胞悬液输注受者肝脏门静脉系统内。受者同时接受免疫抑制药物治疗,术后定期监测血糖、C肽、血清胰岛素浓度及免疫抑制剂浓度,观察围手术期并发症。结果供者胰腺成功分离胰岛细胞,胰岛细胞数量为21×10^4 IEQ,纯度为70%,活率>90%。受者接受胰岛移植后血糖水平逐渐恢复稳定,血糖脆性得到改善,空腹及刺激后C肽水平较前升高,外源性胰岛素用量较移植前明显减少。受者围手术期出现畏寒、发热,给予静脉滴注甲基强的松龙后缓解。未出现酮症酸中毒及低血糖反应,未发生急性排斥反应、感染等并发症。截止投稿日期,受者胰岛素日总剂量减少78%,从49 U/d减到11 U/d,且血糖控制更平稳。结论同种异体胰岛细胞移植治疗成人1型糖尿病是安全、有效的。Objective To evaluate the efficacy and safety of allogeneic islet cell transplantation in the treatment of adult type 1 diabetes mellitus.Methods Clinical data of a recipient with type 1 diabetes mellitus who underwent islet cell transplantation in Foshan First People’s Hospital in December 2018 were retrospectively analyzed.The informed consents of the donor and recipient and/or family members were obtained and the local ethical committee approval was received.The recipient was male and aged 54 years and the donor was male,aged 37 years,undergoing donation after cardiac death.The blood glucose level was normal during organ donation.ABO blood type was the same in the donor and recipient.Human leukocyte antigen (HLA) was well matched.The panel reactive antibody (PRA) was negative.The warm ischemia time was 5 min,and the cold ischemia time was 210 min.The pancreas were harvested by standard total abdominal evisceration (TAE).The islet cells were isolated and purified in islet isolation laboratory,and cultured in transplant medium for 24 h.After the quality,quantity and endotoxin of islet cells met the requirements,the islet cell suspension was infused into the recipient’s liver portal vein system by percutaneous transhepatic catheterization guided by color Doppler ultrasound under digital subtraction angiography (DSA).The recipient was simultaneously treated with immunosuppressive drugs.Blood glucose level,C-peptide level,serum insulin concentration and immunosuppressant concentration were monitored regularly after operation.Perioperative complications were observed.Results The islet cells were successfully isolated from the donor’s pancreas.The quantity of islet cells was 21×10^4 IEQ,the purity was 70%,and the survival rate exceeded 90%.After islet transplantation,the blood glucose level of the recipient was gradually stabilized,the fragility of blood glucose was improved,the C-peptide levels under fasting and after stimulation were increased comparatively,and the dose of exogenous insulin was significantly

关 键 词：移植 同种 胰岛移植 糖尿病 1型 治疗结果 安全性 

分 类 号：R587.1[医药卫生—内分泌]