胰岛移植治疗1型糖尿病的现状和未来

刘颖; 肖平; 陈焕伟

doi:10.3969/j.issn.1674-7445.2019.01.015

胰岛移植治疗1型糖尿病的现状和未来

doi: 10.3969/j.issn.1674-7445.2019.01.015

528000 广东省佛山市第一人民医院胰腺外科（刘颖，陈焕伟），临床研究所（肖平）

基金项目:

2016年高校和医院科研创新平台项目 2016AG100561

详细信息

作者简介:
刘颖，女，硕士，研究方向为胰岛移植，Email:liuying_0210@foxmail.com

通讯作者:
陈焕伟，男，1967年生，主任医师，研究方向为器官移植，Email：chwei_fsyyy@163.com

中图分类号: R617, R657.5
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- 被引次数: 0
出版历程
- 收稿日期: 2018-10-08
- 网络出版日期: 2021-01-19
- 刊出日期: 2019-01-15

Current status and future of islet transplantation for type 1 diabetes

摘要

摘要: 1型糖尿病是一种全球性的慢性自身免疫疾病，会造成机体一系列代谢紊乱综合征，严重危害人类健康。胰岛移植可以通过增加1型糖尿病患者体内胰岛细胞的数量，减少患者对外源性胰岛素的依赖、有效控制血糖以及防治长期并发症，是一种安全可靠的治疗方法，这都是外源性胰岛素治疗和移植风险极高的全胰腺移植无法实现的。本文就胰岛移植供受体选择、胰岛细胞的分离纯化及胰岛移植、胰岛移植后的免疫抑制治疗、胰岛移植后的监测指标、胰岛移植临床应用的现状以及面临的挑战做一综述。
- 胰岛移植 /
- 1型糖尿病 /
- 血糖控制 /
- 胰岛素独立 /
- 免疫抑制 /
- 胰岛素

HTML全文

图 1 胰岛移植后的免疫抑制方案^[10]

诱导方案：抗胸腺细胞球蛋白+依那西普；维持方案：西罗莫司（若受体不耐受该药的不良反应可换为吗替麦考酚酯）+他克莫司

Figure 1. Immunosuppressive regimen after islet transplantation

下载: 全尺寸图片幻灯片

参考文献(18)

[1]	ATKINSON MA, EISENBARTH GS, MICHELS AW. Type 1 diabetes[J]. Lancet, 2014, 383(9911):69-82. DOI: 10.1016/S0140-6736(13)60591-7.
[2]	王西亮, 蔡志明, 牟丽莎. MicroRNA在糖尿病诊断和胰岛移植物监测中的研究进展[J].器官移植, 2018, 9(1):79-82. DOI: 10.3969/j.issn.1674-7445.2018.01.012. WANG XL, CAI ZM, MOU LS. Research progress of microRNA in diagnosis of diabetes mellitus and monitoring of islet transplant allograft[J]. Organ Transplant, 2018, 9(1):79-82. DOI: 10.3969/j.issn.1674-7445.2018.01.012.
[3]	HERING BJ, CLARKE WR, BRIDGES ND, et al. Phase 3 trial of transplantation of human islets in type 1 diabetes complicated by severe hypoglycemia[J]. Diabetes Care, 2016, 39(7):1230-1240. DOI: 10.2337/dc15-1988.
[4]	KIN T, O'GORMAN D, SCHROEDER A, et al. Human islet distribution program for basic research at a single center[J]. Transplant Proc, 2011, 43(9):3195-3197. DOI: 10.1016/j.transproceed.2011.10.003.
[5]	SHAPIRO AM, POKRYWCZYNSKA M, RICORDI C. Clinical pancreatic islet transplantation[J]. Nat Rev Endocrinol, 2017, 13(5):268-277. DOI: 10.1038/nrendo.2016.178.
[6]	MUJTABA M, FRIDELL J, SHARFUDDIN A, et al. BK virus nephropathy in simultaneous pancreas kidney transplant: a potentially preventable cause of kidney allograft loss[J]. Clin Transplant, 2012, 26(2):E87- E93. DOI: 10.1111/j.1399-0012.2012.01599.x.
[7]	RICORDI C, GOLDSTEIN JS, BALAMURUGAN AN, et al. National institutes of health-sponsored clinical islet transplantation consortium phase 3 trial: manufacture of a complex cellular product at eight processing facilities[J]. Diabetes, 2016, 65(11):3418-3428. doi: 10.2337/db16-0234
[8]	SHAPIRO AM, LAKEY JR, RYAN EA, et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen[J]. N Engl J Med, 2000, 343(4):230-238. doi: 10.1056/NEJM200007273430401
[9]	NANJI SA, SHAPIRO AM. Islet transplantation in patients with diabetes mellitus: choice of immunosuppression[J]. BioDrugs, 2004, 18(5):315-328. doi: 10.2165/00063030-200418050-00004
[10]	HERING BJ, KANDASWAMY R, ANSITE JD, et al. Single-donor, marginal-dose islet transplantation in patients with type 1 diabetes[J]. JAMA, 2005, 293(7):830-835. doi: 10.1001/jama.293.7.830
[11]	SHAPIRO AM. Strategies toward single-donor islets of Langerhans transplantation[J]. Curr Opin Organ Transplant, 2011, 16(6):627-631. DOI: 10.1097/MOT.0b013e32834cfb84.
[12]	EL KHATIB MM, SAKUMA T, TONNE JM, et al. β-Cell-targeted blockage of PD1 and CTLA4 pathways prevents development of autoimmune diabetes and acute allogeneic islets rejection[J]. Gene Ther, 2015, 22(5):430-438. DOI: 10.1038/gt.2015.18.
[13]	KLEFFEL S, VERGANI A, TEZZA S, et al. Interleukin-10⁺ regulatory B cells arise within antigen-experienced CD40⁺ B cells to maintain tolerance to islet autoantigens[J]. Diabetes, 2015, 64(1):158-171. DOI: 10.2337/db13-1639.
[14]	LING Z, DE PAUW P, JACOBS-TULLENEERS-THEVISSEN D, et al. Plasma GAD65, a marker for early β-cell loss after intraportal islet cell transplantation in diabetic patients[J]. J Clin Endocrinol Metab, 2015, 100(6):2314-2321. DOI: 10.1210/jc.2015-1216.
[15]	BARTON FB, RICKELS MR, ALEJANDRO R, et al. Improvement in outcomes of clinical islet transplantation: 1999-2010[J]. Diabetes Care, 2012, 35(7):1436-1445. DOI: 10.2337/dc12-0063.
[16]	LABLANCHE S, BOROT S, WOJTUSCISZYN A, et al. Five-year metabolic, functional, and safety results of patients with type 1 diabetes transplanted with allogenic islets within the Swiss-French GRAGIL network[J]. Diabetes Care, 2015, 38(9):1714-1722. DOI: 10.2337/dc15-0094.
[17]	SHAPIRO AM, RICORDI C, HERING BJ, et al. International trial of the Edmonton protocol for islet transplantation[J]. N Engl J Med, 2006, 355(13):1318-1330. doi: 10.1056/NEJMoa061267
[18]	姚豫桐, 魏玲玲, 杨卯竹, 等.同种异体胰岛移植治疗1型糖尿病10例及随访观察3年的临床研究[J].中华器官移植杂志, 2016, 37(2):90-94. DOI: 10.3760/cma.j.issn.0254-1785.2016.02.006. YAO YT, WEI LL, YANG MZ, et al. Allograft islets transplantation for type 1 diabetes mellitus and 3-year follow-up: 10 cases report[J]. Chin J Organ Transplant, 2016, 37(2):90-94. DOI: 10.3760/cma.j.issn.0254-1785.2016.02.006.