论文部分内容阅读
目的基于前期研究,进一步探讨自体外周造血干细胞移植(AHST)治疗1型糖尿病(T1DM)的有效性与安全性。方法环磷酰胺(CY)、粒细胞集落刺激因子动员造血干细胞至外周血,经白细胞分离术分离、处理造血干细胞并予以冻存;采用CY+兔抗胸腺细胞球蛋白预处理后,经静脉或脾动脉插管回输入体内。观察移植前后胰岛素剂量、糖化血红蛋白(HbA_1c)、胰岛功能、胰岛自身抗体等变化;记录治疗期及随访期不良反应。结果 8例患者回输干细胞后:(1)3例患者在不同时期内停用胰岛素;5例患者胰岛素用量较前减少。(2)HbA_1c较移植前显著降低(P<0.05);C肽较移植前不同程度地增加。(3)移植前阳性胰岛自身抗体均转阴。(4)1例患者于移植后6月出现原发性甲减;所有患者均未发生出血性膀胱炎、重度感染等严重不良反应。结论 AHST可不同程度地恢复T1DM患者的胰岛功能,改善其血糖控制,减轻其对外源性胰岛素的依赖性。但是该技术是否能作为常规方法应用于临床,仍待深入研究。
Objective To further investigate the efficacy and safety of autologous peripheral hematopoietic stem cell transplantation (AHST) in the treatment of type 1 diabetes mellitus (T1DM) based on previous studies. Methods Cyclophosphamide (CY) and granulocyte-colony-stimulating factor were used to mobilize hematopoietic stem cells to peripheral blood. The hematopoietic stem cells were separated and treated by leukocyte isolation. The hematopoietic stem cells were cryopreserved. Cytokines were pretreated with CY + Artery intubation back into the body. The changes of insulin dose, HbA 1c, islet function and islet autoantibodies before and after transplantation were observed. The adverse reactions during treatment and follow-up were recorded. Results After 8 patients were transfused with stem cells: (1) 3 patients discontinued insulin at different time points; 5 patients had less insulin. (2) HbA_1c was significantly lower than that before transplantation (P <0.05); C peptide increased to some extent before transplantation. (3) Pre-transplant positive islet autoantibodies were negative. (4) Primary hypothyroidism occurred in one patient at 6 months after transplantation; all patients had no serious adverse reactions such as hemorrhagic cystitis and severe infection. Conclusions AHST can restore the islet function of T1DM patients to varying degrees, improve its blood glucose control and reduce its dependence on exogenous insulin. However, whether this technique can be used as a routine method in clinical practice remains to be further studied.