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目的探讨成人胰岛移植治疗1型糖尿病的临床效果。方法为8例1型糖尿病患者施行胰岛移植,供胰来自于成人尸体,消化、分离获得的胰岛培养过夜,然后经动脉插管输注至肝固有动脉,每例输注胰岛数为(8415±757)胰岛当量/kg。其中3例接受1个供者的胰岛移植,5例接受2个供者的胰岛移植(分2次进行)。8例患者中,除1例供、受者的ABO血型不同外,其余供、受者的ABO血型均相同。本组病例未行HLA配型。术后免疫抑制治疗采用Edmonton方案中的免疫抑制剂使用方法,即不使用类固醇激素,采用西罗莫司和他克莫司联用,并辅以5剂达利珠单抗。术后观察外源性胰岛素的使用量、血糖及血清C-肽的变化。结果移植后平均随访7.7个月,2例完全停用胰岛素,5例的胰岛素用量减少47%～90%,1例效果不明显,胰岛素用量仅减少21%。8例血糖从移植前的(10.6土3.9)mmol/L降至(6.6±1.3)mmol/L,控制更为平稳;糖化血红蛋白A_1从(11.9±1.6)%降至(5.9±1.2)%。移植有效者的血清C-肽基础值及葡萄糖刺激后C-肽水平分别由移植前的(0.054±0.076)nmol/L和(0.075±0.045)nmol/L升高至(0.620±0.080)nmol/L和(1.580±0.770)nmol/L。免疫抑制剂相关的并发症主要为白细胞减少(6例),减少或停用免疫抑制剂后白细胞可回升至正常,无大出血、门静脉栓塞或门静脉高压等并发症发生。结论经肝动脉输注成人胰岛治疗1型糖尿病具有一定的临床效果,采用Edmonton免疫抑制方案安全、有效。
Objective To investigate the clinical effect of islet transplantation in adults with type 1 diabetes. Methods Pancreatic islets were transplanted in 8 patients with type 1 diabetes. The pancreatic islets were obtained from adult cadavers and were digested and isolated overnight. After transcatheter arterial infusion, the islets were transfused into the proper hepatic artery. The number of islets per infusion was (8415 ± 757) Islet equivalent / kg. Three of them received islet transplantation from one donor and five received islet transplantation from two donors (in two runs). Among the 8 patients, ABO blood type was the same except that one donor and recipient had different ABO blood group. This group of patients did not line HLA matching. Postoperative immunosuppressive therapy using Edmonton regimen of immunosuppressive agents that do not use steroid hormones, the use of sirolimus and tacrolimus combined with 5 doses of daclizumab. Postoperative observation of exogenous insulin levels, blood glucose and serum C-peptide changes. Results The patients were followed up for an average of 7.7 months after transplantation. Two patients stopped using insulin completely. The insulin dosage was reduced by 47% -90% in five patients. The effect was not obvious in one patient and only 21% in insulin dosage. The blood glucose level decreased from (10.6 ± 3.9) mmol / L to (6.6 ± 1.3) mmol / L before transplantation in 8 patients, and the control was more stable. Glycated hemoglobin A1 was decreased from (11.9 ± 1.6)% to (5.9 ± 1.2)%. The baseline value of serum C-peptide and the level of C-peptide after glucose stimulation in the transplant recipients were increased from (0.054 ± 0.076) nmol / L and (0.075 ± 0.045) nmol / L before transplantation to (0.620 ± 0.080) L and (1.580 ± 0.770) nmol / L. The main complications associated with immunosuppressants were leucopenia (6 cases). After the immunosuppressive agents were reduced or discontinued, the white blood cells returned to normal without any major bleeding, complications such as portal vein embolization or portal hypertension. Conclusion Transfusion of adult islets via transhepatic arterial infusion in the treatment of type 1 diabetes has some clinical effects. The Edmonton immunosuppressive regimen is safe and effective.