Fiorina Paolo, Gremizzi Chiara, Maffi Paola, Caldara Rossana, Tavano Davide, Monti Lucilla, Socci Carlo, Folli Franco, Fazio Ferruccio, Astorri Ettore, Del Maschio Alessandro, Secchi Antonio
Department of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Diabetes Care. 2005 Jun;28(6):1358-65. doi: 10.2337/diacare.28.6.1358.
Cardiovascular mortality and morbidity are major problems in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to determine whether islet transplantation can improve cardiovascular function in these patients.
We assessed various markers of cardiac function at baseline and 3 years later in a population of 42 type 1 diabetic patients with ESRD who received a kidney transplant. Seventeen patients then received an islet transplant that had persistent function as defined by long-term C-peptide secretion (kidney-islet group). Twenty-five patients did not receive a functioning islet transplant (kidney-only group).
GHb levels were similar in the two groups, whereas the exogenous insulin requirement was lower in the kidney-islet group with persistent C-peptide secretion. Overall, cardiovascular parameters improved in the kidney-islet group, but not in the kidney-only group, with an improvement of ejection fraction (from 68.2 +/- 3.5% at baseline to 74.9 +/- 2.1% at 3 years posttransplantation, P < 0.05) and peak filling rate in end-diastolic volume (EDV) per second (from 3.87 +/- 0.25 to 4.20 +/- 0.37 EDV/s, P < 0.05). Time to peak filling rate remained stable in the kidney-islet group but worsened in the kidney-only group (P < 0.05). The kidney-islet group also showed a reduction of both QT dispersion (53.5 +/- 4.9 to 44.6 +/- 2.9 ms, P < 0.05) and corrected QT (QTc) dispersion (67.3 +/- 8.3 to 57.2 +/- 4.6 ms, P < 0.05) with higher erythrocytes Na(+)-K(+)-ATPase activity. In the kidney-islet group only, both atrial natriuretic peptide and brain natriuretic peptide levels decreased during the follow-up, with a stabilization of intima-media thickness.
Our study showed that type 1 diabetic ESRD patients receiving a kidney transplant and a functioning islet transplant showed an improvement of cardiovascular function for up to 3 years of follow-up compared with the kidney-only group, who experienced an early failure of the islet graft or did not receive an islet graft.
心血管疾病的死亡率和发病率是1型糖尿病终末期肾病（ESRD）患者面临的主要问题。本研究旨在确定胰岛移植是否能改善这些患者的心血管功能。
我们在42例接受肾移植的1型糖尿病ESRD患者群体中，于基线时和3年后评估了各种心脏功能标志物。其中17例患者随后接受了胰岛移植，且根据长期C肽分泌定义具有持续功能（肾-胰岛组）。25例患者未接受有功能的胰岛移植（仅肾组）。
两组的糖化血红蛋白水平相似，而肾-胰岛组中具有持续C肽分泌的患者外源性胰岛素需求量较低。总体而言，肾-胰岛组的心血管参数有所改善，而仅肾组则未改善，射血分数有所提高（从基线时的68.2±3.5%提高到移植后3年时的74.9±2.1%，P<0.05），舒张末期容积（EDV）的每秒峰值充盈率也有所提高（从3.87±0.25提高到4.20±0.37 EDV/s，P<0.05）。肾-胰岛组的峰值充盈率时间保持稳定，而仅肾组则恶化（P<0.05）。肾-胰岛组还显示QT离散度（从53.5±4.9降至44.6±2.9毫秒，P<0.05）和校正QT（QTc）离散度（从67.3±8.3降至57.2±4.6毫秒，P<0.05）均降低，同时红细胞钠钾ATP酶活性更高。仅在肾-胰岛组中，随访期间心房利钠肽和脑利钠肽水平均下降，内膜中层厚度稳定。
我们的研究表明，与胰岛移植早期失败或未接受胰岛移植的仅肾组相比，接受肾移植和有功能胰岛移植的1型糖尿病ESRD患者在长达3年的随访中，心血管功能有所改善。
