极少数Ⅰ型糖尿病患者适于采用胰岛移植手术
【医业网据路透社2002年7月11日纽约讯】对胰岛移植的糖尿病人随访研究表明，本实验性治疗似乎长期有效。据7月的《糖尿病》杂志(Diabetes 2002;51:2148-2157)说，其中一多半病人在两年后还不必使用胰岛素注射液。
“这种胰岛移植术的持续疗效非常之好”，加拿大艾伯特大学的莱恩(Edmond A. Ryan)告诉路透社记者，治疗不会引起并发症，但也如预计的一样，会因使用强效免疫抑制药引起副作用。“最近我才对一个病人说，‘没有免费的午餐’，他回答他认为他得到的利益大于付出的代价”，莱恩说。
Ⅰ型糖尿病有时也称幼年期糖尿病，因为它比Ⅱ型糖尿病发作更早，免疫系统错误地攻击自身的胰岛细胞，导致调节血糖的激素减少或根本不能产生。患者必须每天注射胰岛素。一种实验性治疗方法是移植胰岛，尽管这样可能让患者不用注射胰岛素，但手术也很危险，同时抑制免疫系统的药物也可能引起严重副作用。如今，莱恩和同事报告了17名移植胰岛术的病人的后果，后者平均被随访了20个月。在15位至少被随访了1年的病人中，有9人(60%)不再需要注射胰岛素了；在至少被随访了2年的6人中，有4人(67%)停掉了胰岛素。即使对重新开始注射药物的病人，也有一半人只需以前50%的用量。
, http://www.100md.com
尽管移植疗果不错，但莱恩和同事说，还有提高的余地。治疗引起了不少副反应，如血栓、出血、胆固醇和肌氨酸酐(肾病的标志)升高。因此，本方法只适于少数很难控制血糖的Ⅰ型糖尿病患者(约占5%-10%)。“将来如果本方法更加安全，也找到了其它胰岛来源，可能适用的人更多一些”，莱恩说。
Transplant May Help Some Type 1 Diabetics: Study
Thu Jul 11, 1:49 PM ET
By Merritt McKinney
NEW YORK (Reuters Health) - Researchers following diabetics ( news - web sites) who have undergone a treatment called islet transplantation report that the benefits of the experimental therapy seem to be long lasting. More than half of the patients still don't require insulin injections more than 2 years after treatment, according to a report in the July issue of the journal Diabetes.
, 百拇医药
"The islet transplant procedure is continuing to give very good results," Dr. Edmond A. Ryan of the University of Alberta in Edmonton, Alberta, Canada, told Reuters Health. The treatment does cause complications, but he said that these side effects are "no more than would be expected" from the use of powerful immune-suppressing drugs that keep the body from rejecting the transplanted cells.
"I said to one of my patients recently, 'There is no free lunch,' and he said he thought the price he paid in terms of adverse events was well worth it for the benefits obtained," Ryan said.
, http://www.100md.com
Type 1 diabetes is sometimes called juvenile diabetes because it usually strikes at a younger age than the more common type 2 diabetes. In type 1 diabetes, the immune system launches a misguided attack against pancreatic cells called beta cells, which produce insulin. This leads to low or nonexistent levels of the sugar-regulating hormone. People with this type of diabetes must take daily insulin injections to survive.
One experimental approach to treating type 1 diabetes is to transplant islets, which are clusters of cells in the pancreas that contain beta cells. Though islet transplantation has the potential to free diabetics from daily insulin injections, the treatment is risky, and immune-suppressing drugs can cause serious side effects.
, 百拇医药
Ryan and his colleagues now report the outcome of 17 patients who have completed the islet transplantation procedure and have been followed for an average of about 20 months. Of the 15 patients who have been followed for at least a year, 9 (60%) no longer need to take insulin. Of those who had been followed for at least two years, 4 out of 6 (67%) were off insulin, according to the report.
Even though several patients had to resume taking insulin, half are using a 50% lower dose of insulin than before the transplant.
, http://www.100md.com
Despite the benefits of the transplant, there is definitely room for improvement, Ryan and his colleagues point out. The treatment was associated with a variety of side effects, including blood clots, bleeding, elevated cholesterol levels and a rise in creatinine, which is a marker for kidney disease.
Right now, islet transplantation is suitable only for a small percentage of people with type 1 diabetes, according to Ryan. The group most likely to benefit is a subset of type 1 patients who have great difficulty controlling their blood sugar, or glucose, levels despite the best treatment, he said. This group accounts for 5% to 10% of people with type 1 diabetes, he said.
"In time, as the procedure becomes safer and if other sources of islets can be found, it could apply to many more," he said.
SOURCE: Diabetes 2002;51:2148-2157., http://www.100md.com
“这种胰岛移植术的持续疗效非常之好”，加拿大艾伯特大学的莱恩(Edmond A. Ryan)告诉路透社记者，治疗不会引起并发症，但也如预计的一样，会因使用强效免疫抑制药引起副作用。“最近我才对一个病人说，‘没有免费的午餐’，他回答他认为他得到的利益大于付出的代价”，莱恩说。
Ⅰ型糖尿病有时也称幼年期糖尿病，因为它比Ⅱ型糖尿病发作更早，免疫系统错误地攻击自身的胰岛细胞，导致调节血糖的激素减少或根本不能产生。患者必须每天注射胰岛素。一种实验性治疗方法是移植胰岛，尽管这样可能让患者不用注射胰岛素，但手术也很危险，同时抑制免疫系统的药物也可能引起严重副作用。如今，莱恩和同事报告了17名移植胰岛术的病人的后果，后者平均被随访了20个月。在15位至少被随访了1年的病人中，有9人(60%)不再需要注射胰岛素了；在至少被随访了2年的6人中，有4人(67%)停掉了胰岛素。即使对重新开始注射药物的病人，也有一半人只需以前50%的用量。
, http://www.100md.com
尽管移植疗果不错，但莱恩和同事说，还有提高的余地。治疗引起了不少副反应，如血栓、出血、胆固醇和肌氨酸酐(肾病的标志)升高。因此，本方法只适于少数很难控制血糖的Ⅰ型糖尿病患者(约占5%-10%)。“将来如果本方法更加安全，也找到了其它胰岛来源，可能适用的人更多一些”，莱恩说。
Transplant May Help Some Type 1 Diabetics: Study
Thu Jul 11, 1:49 PM ET
By Merritt McKinney
NEW YORK (Reuters Health) - Researchers following diabetics ( news - web sites) who have undergone a treatment called islet transplantation report that the benefits of the experimental therapy seem to be long lasting. More than half of the patients still don't require insulin injections more than 2 years after treatment, according to a report in the July issue of the journal Diabetes.
, 百拇医药
"The islet transplant procedure is continuing to give very good results," Dr. Edmond A. Ryan of the University of Alberta in Edmonton, Alberta, Canada, told Reuters Health. The treatment does cause complications, but he said that these side effects are "no more than would be expected" from the use of powerful immune-suppressing drugs that keep the body from rejecting the transplanted cells.
"I said to one of my patients recently, 'There is no free lunch,' and he said he thought the price he paid in terms of adverse events was well worth it for the benefits obtained," Ryan said.
, http://www.100md.com
Type 1 diabetes is sometimes called juvenile diabetes because it usually strikes at a younger age than the more common type 2 diabetes. In type 1 diabetes, the immune system launches a misguided attack against pancreatic cells called beta cells, which produce insulin. This leads to low or nonexistent levels of the sugar-regulating hormone. People with this type of diabetes must take daily insulin injections to survive.
One experimental approach to treating type 1 diabetes is to transplant islets, which are clusters of cells in the pancreas that contain beta cells. Though islet transplantation has the potential to free diabetics from daily insulin injections, the treatment is risky, and immune-suppressing drugs can cause serious side effects.
, 百拇医药
Ryan and his colleagues now report the outcome of 17 patients who have completed the islet transplantation procedure and have been followed for an average of about 20 months. Of the 15 patients who have been followed for at least a year, 9 (60%) no longer need to take insulin. Of those who had been followed for at least two years, 4 out of 6 (67%) were off insulin, according to the report.
Even though several patients had to resume taking insulin, half are using a 50% lower dose of insulin than before the transplant.
, http://www.100md.com
Despite the benefits of the transplant, there is definitely room for improvement, Ryan and his colleagues point out. The treatment was associated with a variety of side effects, including blood clots, bleeding, elevated cholesterol levels and a rise in creatinine, which is a marker for kidney disease.
Right now, islet transplantation is suitable only for a small percentage of people with type 1 diabetes, according to Ryan. The group most likely to benefit is a subset of type 1 patients who have great difficulty controlling their blood sugar, or glucose, levels despite the best treatment, he said. This group accounts for 5% to 10% of people with type 1 diabetes, he said.
"In time, as the procedure becomes safer and if other sources of islets can be found, it could apply to many more," he said.
SOURCE: Diabetes 2002;51:2148-2157., http://www.100md.com