药物治疗和胰岛细胞移植对糖尿病肾病的影响：中期报告。

The effect of medical therapy and islet cell transplantation on diabetic nephropathy: an interim report.

作者信息

Fung Michelle A, Warnock Garth L, Ao Ziliang, Keown Paul, Meloche Mark, Shapiro R Jean, Ho Stephen, Worsley Dan, Meneilly Graydon S, Al Ghofaili Khalid, Kozak Sharon E, Tong Suet On, Trinh Mary, Blackburn Lorraine, Kozak Robert M, Fensom Blake A, Thompson David M

机构信息

Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

出版信息

Transplantation. 2007 Jul 15;84(1):17-22. doi: 10.1097/01.tp.0000265502.92321.ab.

DOI:10.1097/01.tp.0000265502.92321.ab

PMID:17627232

Abstract

BACKGROUND

The effect of islet cell transplantation (ICT) on renal function in type 1 diabetes is uncertain and some recent studies report a significant decline in estimated glomerular filtration rate (GFR) and worsening of albuminuria.

METHODS

We are conducting a prospective crossover study comparing medical treatment with islet transplantation on the progression of diabetic complications, including renal function. The primary endpoint is change in GFR measured by Tc-diethylenetriaminepentaacetate with secondary endpoints including estimated GFR and albumin excretion.

RESULTS

We have followed 21 patients after islet transplantation a median of 29 months (range 13-45) and compared their results with medically treated patients followed a median 29.5 months (range 13-56). There is no difference in the rate of decline in measured GFR between medically treated patients (-0.35+/-0.89; 95% CI: -0.57 to -0.13 mL/min/month/1.73 m) and those after ICT (-0.31+/-1.18; 95% CI: -0.61 to -0.01) and neither is significantly different from that expected for the general population. The rate of decline in our estimated GFR results is lower than that reported in other studies and we did not find any worsening of albuminuria.

CONCLUSIONS

We do not find evidence of worsening of renal function after islet transplantation compared with medically treated patients.

摘要

背景

胰岛细胞移植（ICT）对1型糖尿病患者肾功能的影响尚不确定，最近一些研究报告称估算肾小球滤过率（GFR）显著下降且蛋白尿加重。

方法

我们正在进行一项前瞻性交叉研究，比较药物治疗与胰岛移植对糖尿病并发症进展的影响，包括肾功能。主要终点是用锝-二乙烯三胺五乙酸测量的GFR变化，次要终点包括估算GFR和白蛋白排泄。

结果

我们对21例胰岛移植后的患者进行了中位时间为29个月（范围13 - 45个月）的随访，并将他们的结果与接受药物治疗的患者进行比较，后者的中位随访时间为29.5个月（范围13 - 56个月）。接受药物治疗的患者（-0.35±0.89；95%可信区间：-0.57至-0.13 mL/min/月/1.73 m²）与胰岛移植后的患者（-0.31±1.18；95%可信区间：-0.61至-0.01）之间，实测GFR的下降速率没有差异，且两者与一般人群预期的下降速率均无显著差异。我们估算GFR结果的下降速率低于其他研究报告的速率，并且我们没有发现蛋白尿加重的情况。