同种异体胰岛联合自体外周血干细胞移植治疗1型糖尿病:随访3年的临床研究  

Allogeneic islets combined with autologous peripheral blood stem cell transplantation in treatment of type 1 diabetes mellitus: a 3-year follow-up clinical study

作　　者：姚豫桐[1] 赖春友 冯天航 尚进 杨钦焱 杨卯竹[1] 张雯[1] 黄孝伦[1] YAO Yutong;LAI Chunyou;FENG Tianhang;SHANG Jin;YANG Qinyan;YANG Maozhu;ZHANG Wen;HUANG Xiaolun(Department of Hepatobiliary and Pancreatic Surgery Center&Cell Transpiantation Center,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,Chengdu 610072,P.R.China)

机构地区：[1]四川省医学科学院·四川省人民医院肝胆胰外科中心&细胞移植中心,成都610072

出　　处：《中国普外基础与临床杂志》2022年第9期1189-1194,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省科技计划项目重点研发项目(项目编号:2018SZ0110);四川省干部保健科研课题普通课题项目(项目编号:川干研2018-236)。

摘　　要：目的 评估同种异体胰岛联合自体外周血干细胞移植治疗1型糖尿病的3年随访结果。方法 回顾性分析2017年1月至2019年12月期间四川省人民医院完成的同种异体胰岛细胞联合(或不联合)干细胞移植受者的临床病理资料。经皮经肝门静脉穿刺方式移植同种异体胰岛细胞联合(或不联合)干细胞,术后采用改良的Edmonton免疫抑制方案,随访3年,分析移植术后受者的胰岛素使用、C肽水平及糖化血红蛋白(hemoglobin A1c,HbA1c)浓度情况。结果 单独同种异体胰岛细胞移植受者5例(简称“单独组”),同种异体胰岛细胞联合干细胞移植受者5例(简称“联合组”),2组受者的性别、年龄、体质量指数、术前胰岛素用量及HbA1c浓度相近。①单独组和联合组移植胰岛数量分别为(50.60±2.51)×10^(4)胰岛当量(islet equivalent quantity,IEQ)和(48.70±4.76)×10^(4) IEQ,联合组的5例受者移植干细胞数量(9.2±2.6)×10^(7)个。②单独组和联合组受者术后第12个月时分别均有3例撤除胰岛素,至术后第36个月时分别有2例和3例撤除胰岛素;2组术后胰岛素用量均较术前下降,在术后12个月内,联合组胰岛素用量呈现出低于单独组的趋势。③单独组空腹C肽水平术后第24个月时达高峰后开始下降,联合组空腹和餐后2 h C肽水平均在术后第12个月时达到高峰后开始下降,而在术后第24个月时餐后2 h C肽水平呈上升趋势,与单独组相比,联合组在术后第12个月和第36个月时的C肽水平表现出更高的趋势。④术后36个月内,2组的HbA1c浓度在术后不同时间点均较术前下降,至术后第6个月时基本维持正常平稳水平,2组的变化趋势基本一致。⑤ 2组均无明显的免疫排斥反应及不良反应。结论 从本研究初步结果看,自体外周血干细胞对胰岛移植具有一定的保护作用,使同种异体胰岛移植后3年的临床疗效有所改善,但其远期疗效仍需进一步随访观察,其机Objective To evaluate the 3-year follow-up results of allogeneic islets combined with autologous peripheral blood stem cells(PBSC) transplantation in treatment of type 1 diabetes mellitus(T1MD). Methods The clinicopathologic data of recipients underwent allogeneic islet cells combined with(or without) PBSC transplantation in the Sichuan Provincial People’s Hospital from January 2017 to December 2019 were retrospectively analyzed. The allogeneic islet cells combined with(or without) PBSC were infused into the liver by percutaneous hepatic portal vein puncture. Then the modified Edmonton immunosuppressive regimen was used after the operation. The recipients were followed-up for 3 years, and the insulin usage, C-peptide, and glycosylated hemoglobin A1c(HbA1c) were analyzed.Results There were 5 recipients of allogeneic islet cell transplantation alone(named as alone group) and 5 recipients of allogeneic islet cell combined with PBSC transplantation(named as combined group). The gender, age, body mass index, preoperative insulin dosage, and HbA1c concentration of the recipients in the two groups were similar.① The numbers of islets transplanted in the alone group and combined group were(50.60±2.51)×10^(4) islet equivalent quantity(IEQ) and(48.70±4.76)×10^(4) IEQ, respectively, and the number of PBSC transplanted in the combined group was(9.2±2.6)×10^(7).② In the alone group and combined group, there were 3 cases and 3 cases of insulin withdrawal at the 12th month, as well as 2 cases and 3 cases of insulin withdrawal at the 36th month after operation, respectively. The postoperative insulin dosages of the two groups were decreased as compared with that before operation, and which of the combined group showed a lower trend as compared with the alone group within 12 months after operation.③ The C-peptide level at the fasting in the alone group peaked at 24th month after operation and began to decline, and which at the fasting and postprandial 2 h peaked at 12th month after operation and began to decline, bu

关 键 词：胰岛移植 糖尿病 干细胞 

分 类 号：R457.7[医药卫生—治疗学] R587.1[医药卫生—临床医学]