同时进行胰腺和抢先肾移植（SPPkTx）的1型糖尿病合并终末期糖尿病肾病患者与纳入透析项目患者的治疗结果比较——一项队列研究。

The comparison of treatment results of type 1 diabetes mellitus complicated by end-stage diabetic nephropathy in patients undergoing simultaneous pancreas and pre-emptive kidney transplantation (SPPkTx) and patients enrolled into the dialysis program--a cohort study.

作者信息

Grochowiecki Tadeusz, Szmidt Jacek, Gałazka Zbigniew, Nazarewski Sławomir, Madej Krzysztof, Frunze Sławomir, Wyzgał Janusz, Senatorski Grzegorz, Jakimowicz Tomasz, Pietrasik Kamil, Wojtaszek Mikołaj, Grygiel Katarzyna, Chudziński Witold, Siciński Marcin, Kański Andrzej, Paczek Leszek

机构信息

Department of General, Vascular and Transplant Surgery, The Medical University of Warsaw.

出版信息

Ann Transplant. 2005;10(3):31-5.

PMID:16617664

Abstract

OBJECTIVE

A cohort study was conducted to compare treatment of patients with type 1 diabetes mellitus and end-stage diabetic nephropathy.

PATIENTS AND METHODS

47 type 1 diabetic patients required renal replacement therapy in years: 2001-2005 were enrolled. Simultaneous pancreas and preemptive kidney transplant (sppktx) was performed in 18 (group I). Group II consisted of 29 patients who entered dialysis program. Survival rate for patients from both groups was estimated. Transplanted organ function was evaluated for group II. Lipid profile and its correlation with thickness of carotid media was assessed. Impact of sppktx on diabetic retinopathy was investigated. Cost and life quality were compared between groups.

RESULTS

Two-year cumulative recipient survival rate for group I and II was 100% and 96%, respectively. One-year cumulative survival rate for transplanted pancreas was 88% and for kidney grafts 94%. In group I cholesterol and triglyceride level before transplantation were: 207 +/- 38 mg/dl and 133 +/- 65 mg/dl and decreased after transplantation to 155 +/- 20 mg/dl and 78 +/- 25 mg/dl, respectively (p < 0.05). No difference of carotid media thickness was observed between groups. Stabilization of retinopathy was observed in 91.6% non-blind recipients. During the first year of the follow-up the costs of transplantation doubled those of dialysis therapy but in the second year the costs of dialysis exceeded the costs required for transplanted patients.

CONCLUSION

Despite of major surgery and introduction of immunosuppression in group I, results did not differ significantly between groups during a two-year follow-up. After sppktx, stabilization of the carotid media was slower than the normalization of lipids. At the second year, transplantation is less expensive than dialysis.

摘要

目的

进行一项队列研究以比较1型糖尿病合并终末期糖尿病肾病患者的治疗方法。

患者与方法

纳入2001年至2005年间47例需要肾脏替代治疗的1型糖尿病患者。18例患者接受了同期胰腺和抢先肾移植（sppktx）（第一组）。第二组由29例进入透析程序的患者组成。评估两组患者的生存率。对第二组患者的移植器官功能进行评估。评估血脂谱及其与颈动脉中层厚度的相关性。研究sppktx对糖尿病视网膜病变的影响。比较两组的费用和生活质量。

结果

第一组和第二组患者的两年累计受者生存率分别为100%和96%。移植胰腺的一年累计生存率为88%，肾移植为94%。第一组患者移植前胆固醇和甘油三酯水平分别为207±38mg/dl和133±65mg/dl，移植后分别降至155±20mg/dl和78±25mg/dl（p<0.05）。两组间颈动脉中层厚度无差异。91.6%非失明受者的视网膜病变得到稳定。在随访的第一年，移植费用是透析治疗费用的两倍，但在第二年，透析费用超过了移植患者所需的费用。