Coppelli Alberto, Giannarelli Rosa, Vistoli Fabio, Del Prato Stefano, Rizzo Gaetano, Mosca Franco, Boggi Ugo, Marchetti Piero
Department of Endocrinology and Metabolism, Metabolic Unit, Ospedale Cisanello, via Paradisa 2, 56100 Pisa, Italy.
Diabetes Care. 2005 Jun;28(6):1366-70. doi: 10.2337/diacare.28.6.1366.
Pancreas transplant alone can be effective in significantly improving the quality of life of type 1 diabetic patients, and it can also eliminate acute diabetes complications, such as hypoglycemic and/or hyperglycemic episodes. The effects of pancreas transplant alone on long-term complications of diabetes, including nephropathy, are still not settled. We evaluated whether restoration of long-lasting normoglycemia by pancreas transplant alone might have beneficial action on diabetic nephropathy.
A total of 32 type 1 diabetic patients were evaluated before and 1 year after successful pancreas transplant alone, together with 30 matched nontransplanted type 1 diabetic subjects. Several metabolic and kidney function parameters were measured, including plasma glucose, glycohemoglobin (A1C), C-peptide, plasma lipids, blood pressure, creatinine, creatinine clearance, and urinary protein excretion.
Pancreas transplant alone restored sustained normoglycemia, without exogenous insulin administration, and improved plasma lipid levels. Blood pressure decreased significantly. Creatinine concentrations and clearances did not differ before and after transplantation. Urinary protein excretion decreased significantly after pancreas transplant alone, with four microalbuminuric and three macroalbuminuric patients who became normoalbuminuric. None of these changes occurred in the nontransplanted group.
Successful pancreas transplant alone, through restoration of sustained normoglycemia, improves diabetic nephropathy in type 1 diabetic patients.
单纯胰腺移植可有效显著改善1型糖尿病患者的生活质量，还可消除急性糖尿病并发症，如低血糖和/或高血糖发作。单纯胰腺移植对糖尿病长期并发症（包括肾病）的影响仍未明确。我们评估了单纯胰腺移植恢复持久正常血糖水平是否可能对糖尿病肾病产生有益作用。
共对32例1型糖尿病患者在成功进行单纯胰腺移植前及移植后1年进行评估，同时选取30例匹配的未移植1型糖尿病患者作为对照。测量了多个代谢和肾功能参数，包括血糖、糖化血红蛋白（A1C）、C肽、血脂、血压、肌酐、肌酐清除率和尿蛋白排泄量。
单纯胰腺移植在未使用外源性胰岛素的情况下恢复了持续正常血糖水平，并改善了血脂水平。血压显著下降。移植前后肌酐浓度和清除率无差异。单纯胰腺移植后尿蛋白排泄量显著下降，4例微量白蛋白尿患者和3例大量白蛋白尿患者转为正常白蛋白尿。未移植组未出现这些变化。
单纯胰腺移植成功通过恢复持续正常血糖水平，改善了1型糖尿病患者的糖尿病肾病。
