Landgraf R, Nusser J, Riepl R L, Fiedler F, Illner W D, Abendroth D, Land W
Department of Internal Medicine, Klinikum Innenstadt, FRG.
Diabetologia. 1991 Aug;34 Suppl 1:S61-7. doi: 10.1007/BF00587622.
Long-term normalization of glucose metabolism is necessary to prevent or ameliorate diabetic complications. Although pancreatic grafting is able to restore normal blood glucose and glycated haemoglobin, the degree of normalization of the deranged diabetic metabolism after pancreas transplantation is still questionable. Consequently glucose, insulin, C-peptide, glucagon, and pancreatic polypeptide responses to oral glucose and i.v. arginine were measured in 36 Type 1 (insulin-dependent) diabetic recipients of pancreas and kidney allografts and compared to ten healthy control subjects. Despite normal HbA1 (7.2 +/- 0.2%; normal less than 8%) glucose disposal was normal only in 44% and impaired in 56% of the graft recipients. Normalization of glucose tolerance was achieved at the expense of hyperinsulinaemia in 52% of the subjects. C-peptide and glucagon were normal, while pancreatic polypeptide was significantly higher in the graft recipients. Intravenous glucose tolerance (n = 21) was normal in 67% and borderline in 23%. Biphasic insulin release was seen in patients with normal glucose tolerance. Glucose tolerance did not deteriorate up to 7 years post-transplant. In addition, stress hormone release (cortisol, growth hormone, prolactin, glucagon, catecholamines) to insulin-induced hypoglycaemia was examined in 20 graft recipients and compared to eight healthy subjects. Reduced blood glucose decline indicates insulin resistance, but glucose recovery was normal, despite markedly reduced catecholamine and glucagon release. These data demonstrate the effectiveness of pancreatic grafting in normalizing glucose metabolism, although hyperinsulinaemia and deranged counterregulatory hormone response are observed frequently.
葡萄糖代谢的长期正常化对于预防或改善糖尿病并发症是必要的。尽管胰腺移植能够恢复正常血糖和糖化血红蛋白，但胰腺移植后紊乱的糖尿病代谢的正常化程度仍存在疑问。因此，对36名接受胰腺和肾脏同种异体移植的1型（胰岛素依赖型）糖尿病患者进行了口服葡萄糖和静脉注射精氨酸后的葡萄糖、胰岛素、C肽、胰高血糖素和胰多肽反应的测量，并与10名健康对照者进行了比较。尽管糖化血红蛋白正常（7.2±0.2%；正常低于8%），但仅44%的移植受者葡萄糖处置正常，56%的移植受者葡萄糖处置受损。52%的受试者以高胰岛素血症为代价实现了糖耐量正常化。移植受者的C肽和胰高血糖素正常，而胰多肽显著升高。静脉葡萄糖耐量（n = 21）67%正常，23%临界。糖耐量正常的患者出现双相胰岛素释放。移植后长达7年糖耐量没有恶化。此外，对20名移植受者进行了胰岛素诱导低血糖时应激激素释放（皮质醇、生长激素、催乳素、胰高血糖素、儿茶酚胺）的检查，并与8名健康受试者进行了比较。血糖下降减少表明存在胰岛素抵抗，但尽管儿茶酚胺和胰高血糖素释放明显减少，血糖恢复正常。这些数据表明胰腺移植在使葡萄糖代谢正常化方面是有效的，尽管经常观察到高胰岛素血症和反调节激素反应紊乱。
