肾移植后胰岛移植治疗2型糖尿病1例  

Islet transplantation after kidney transplantation for type 2 diabetes mellitus:1 cases report

作　　者：刘婷婷[1] 陈旭春[1] 牛猛[2] 王树森[3] 王晓黎[4] 鲍志野[1] 孙赫 李弘[1] 刘文师 韩阳[5] 刘永锋[1] 程颖[1] Liu Tingting;Chen Xuchun;Niu Meng;Wang Shusen;Wang Xiaoli;Bao Zhiye;Sun He;Li Hong;Liu Wenshi;Han Yang;Liu Yongfeng;Cheng Ying(Department of Transplantation and General Surgery,First Hospital of China Medical University,Shenyang 110001,Liaoning,China;Department of Interventional Radiology,First Hospital of China Medical University,Shenyang 110001,Liaoning,China;Tianjin First Central Hospital Transplant Center,Tianjin 300192,China;Department of Endocrinology,First Hospital of China Medical University,Shenyang 110001,Liaoning,China;Department of Pathology,First Hospital of China Medical University,Shenyang 110001,Liaoning,China.)

机构地区：[1]中国医科大学附属第一医院器官移植暨肝胆外科,辽宁沈阳110001 [2]中国医科大学附属第一医院介入科,辽宁沈阳110001 [3]天津市第一中心医院移植中心,天津300192 [4]中国医科大学附属第一医院内分泌科,辽宁沈阳110001 [5]中国医科大学附属第一医院病理科,辽宁沈阳110001

出　　处：《实用器官移植电子杂志》2022年第5期395-400,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：辽宁省教育厅2020年度科学研究经费项目(FWZR2020002)。

摘　　要：目的探讨肾移植后行胰岛移植治疗2型糖尿病(type 2 diabetes mellitus,T2DM)的安全性及有效性。方法1例慢性肾功能衰竭合并T2DM的患者在肾移植术后3个月行胰岛移植治疗。患者在移植前依赖胰岛素治疗,用量为1.26 U/(kg·d)。采用TIPS入路手术:经颈内静脉插入穿刺导管,通过肝右静脉,在肝实质内穿刺门静脉右支,建立门体通道,置管入门静脉主干,将移植的胰岛细胞缓慢注入受者肝脏中。免疫诱导应用巴利昔单抗,联合依那西普。术后免疫抑制方案继续应用他克莫司、吗替麦考酚酯。术后监测血糖、糖化血红蛋白、胰岛素功能系列、以及外源胰岛素用量等。结果术后当日血糖正常,暂停外源胰岛素,术后1周空腹血糖4.8~8.5 mmol/L,餐后血糖6.9~15.1 mmol/L,术后1周外源胰岛素总量较术前下降了50.14%。术后1周受者糖化血红蛋白为6.3%(术前为6.6%)。术后空腹及餐后C肽及胰岛素水平较术前均有所增长。术后1周行胰岛素释放及C肽释放试验结果提示移植胰岛功能部分恢复,胰岛素分泌有节律。结论肾移植后胰岛移植对胰岛素依赖的2型糖尿病是一种有效且安全的治疗方式。Objective To evaluate the effect and safty of islet transplantation after kidney transplantation for patients with type 2 diabetes mellitus(T2DM)and end-stage renal disease.Methods One case of islet transplantation was performed on a patient with T2DM complicated with chronic renal failure who had received kidney transplantation 3 months ago.The recipient was given exgenous insulin therapy with a dose of 1.26 U/(kg·d)before islet transplantation.The islets were transplanted into the liver through interna jugular vein transhepatic portal catheterization,as TIPS approach,the portal channel was established within the main portal vein,and the islets were slowly injected into the recipient's liver at a constant speed.Anti-CD25 monoclonal antibody was used as induction and a combination ofetanercept,mycophenolate mofetil and tacrolimus were used as maintenance immunosuppression therapy.Insulin dose,the level of blood glucose,C-peptide and the value of HbA1c were observed.Results Blood glucose was normal soon after operation,and the exogenous insulin was suspended.The fasting blood glucose was 4.8~8.5 mmol/L and the postprandialblood glucose was 6.9~15.1 mmol/L within the first week after operation.The total amount of exogenous insulin decreased by 50.14%compared with that before operation.The value of HbA1c was 6.3%within the first week after operation(the level of HbA1c was 6.6%before operation).The fasting and postprandial C-peptide and insulin levels increased after operation.On the 7th day after operation,insulin and C-peptide release tests were performed.The results showed that the function of transplanted islets was partially restored,and insulin secretion was rhythmic.Conclusion Islet transplantation is an effective treatment for T2DM patients with ESRD after kidney transplantation.

关 键 词：胰岛移植 2型糖尿病 免疫抑制剂 

分 类 号：R587.2[医药卫生—内分泌] R699.2[医药卫生—内科学]