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Diabetes Care:胰岛移植或改善糖尿病相关动脉粥样硬化

2012-12-04 Diabetes Care Diabetes Care

胰岛移植糖尿病动脉粥样硬化内膜中膜厚度
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　　来自美国的一项研究表明，胰岛移植可能改善糖尿病相关的动脉粥样硬化。这可能通过恢复内源性胰岛素分泌，继以改善血糖控制，以及移植后优化的脂质调控予以实现。研究在2012年11月19日在线发表于《糖尿病护理》（Diabetes Care）杂志。 　　该研究旨在评价对于无肾脏疾病的1型糖尿病患者，胰岛移植对颈动脉内膜中膜厚度（cIMT，作为动脉粥样硬化的标志）的影响。 　　研究连续纳入1

　　来自美国的一项研究表明，胰岛移植可能改善糖尿病相关的动脉粥样硬化。这可能通过恢复内源性胰岛素分泌，继以改善血糖控制，以及移植后优化的脂质调控予以实现。研究在2012年11月19日在线发表于《糖尿病护理》（Diabetes Care）杂志。

　　该研究旨在评价对于无肾脏疾病的1型糖尿病患者，胰岛移植对颈动脉内膜中膜厚度（cIMT，作为动脉粥样硬化的标志）的影响。

　　研究连续纳入15例成人1型糖尿病患者（平均年龄为49岁，87％为女性），糖尿病持续时间≥5年的（平均持续时间为30年；平均糖化血红蛋白HbA1c为7.2％，无肾脏疾病，存在严重的低血糖意识丧失。所有受试者在1/2期和3期临床试验中，均接受了异体胰岛移植治疗（1到3个胰岛）。当前随访时间范围从1至5年（2005-2011）。在首次胰岛移植治疗之前和之后每12-16个月，对受试者颈总动脉和颈内动脉的cIMT进行测量（每个受试者测量2到6次cIMT），由一位超声检查操作者和一位盲法读者进行测量。在12-50个月的随访期间分析cIMT较基线水平的变化，采用cIMT的综合得分评价，其计算方法为两个动脉标准化IMT得分的总和。

　　结果表明，胰岛移植治疗一到三个月后，所有患者均实现了胰岛素的非依赖。在随访第12个月时，共有15例受试者的颈总动脉cIMT（-0.058，P=0.006）和综合评分（-1.28 SD，P=0.004）下降。在50个月的随访时间组（n=7），综合评分从第12个月（-1.59 SD，P=0.04）到第50个月（-0.77 SD，P=0.04）持续下降。在随访期间，cIMT变化的下降斜率与糖化血红蛋白、脂蛋白和心血管或炎症标志物变化的下降斜率相关。


OBJECTIVE 
Determine the impact of islet transplantation on carotid intima-media thickness (CIMT), a marker for atherosclerosis, in type 1 diabetes without kidney disease.
RESEARCH DESIGN AND METHODS 
Consecutive case series of 15 adults (mean age [SD], 49 years [10 years]; 87% female) with type 1 diabetes for ≥5 years (mean duration [SD], 30 years [12 years]; mean HbA1c [SD], 7.2% [0.9%]), without kidney disease, presenting with severe hypoglycemic unawareness to undergo allogeneic pancreatic islet transplant(s) (one to three each) in a phase 1/2 and 3 clinical trial. Current follow-up ranges from 1 to 5 years (2005–2011). CIMT of the common and internal carotid arteries was measured before and every 12–16 months after the first transplant (two to six CIMTs each) by one ultrasonographer and one blinded reader. CIMT was analyzed as change from baseline to 12- and 50-month follow-up; a combined CIMT score was calculated as the sum of the standardized IMT scores (SD units [SDs]) of both arteries.
RESULTS 
All patients achieved insulin independence after one to three transplants. CIMT decreased at 12 months (n = 15) for the common carotid (−0.058 mm; P = 0.006) and combined score (−1.28 SDs; P = 0.004). In those with 50-month follow-up (n = 7), the decrease in the combined score continued from 12 (−1.59 SDs; P = 0.04) to 50 months (−0.77 SDs; P = 0.04). During follow-up, the decreasing slope of change in CIMT was associated with decreasing slopes of change in HbA1c, lipoproteins, and cardiovascular/inflammatory markers.
CONCLUSIONS 
Islet transplantation may ameliorate diabetes-related atherosclerosis through improved glycemic control consequent to restoring endogenous insulin secretion, and optimal lipid management posttransplant also contributes.
    

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    2013-04-03 ms5439512287675881

    #BET#

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    2012-12-20 baoya

    #胰岛#

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    2013-10-09 ms9608593228839890

    #DIA#

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    2013-10-30 晓辰

    #胰岛移植#

    0

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    2013-05-10 huangshifeng

    #粥样硬化#

    0

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    2012-12-04 木头人513

    #Diabetes#

    0

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　9月16日，在欧洲糖尿病研究学会（EASD）2011年会口头报告会上，瑞士学者的一项研究表明，单次初始胰岛移植和多次初始胰岛移植在血糖控制和严重低血糖发生率方面效果相当，但胰岛供体需要量较少，外源性胰岛素需求量较高。 　　此项研究的受试者为接受胰岛-肾脏联合移植或肾脏-胰岛序贯移植的患者。将受试者分为多次初始胰岛移植组（11例，最多移植5次；第一组）和单次初始胰岛移植组（22例，仅在未能实现良

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