Rangel Erika B, Melaragno Cláudio S, Neves Maria Deolinda F, Dib Sérgio A, Gonzalez Adriano M, Linhares Marcelo M, Pacheco-Silva Alvaro, Sá João R
Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil.
Exp Clin Transplant. 2010 Mar;8(1):29-37.
We used homeostasis model assessment to investigate insulin sensitivity and secretion after a simultaneous pancreas-kidney transplant or kidney transplant alone. In that model, fasting plasma glucose and C-peptide levels are used to evaluate insulin sensitivity and beta-cell function.
Factors (eg, age, sex, race, delayed kidney allograft function) were correlated with homeostasis model assessment of beta-cell function and homeostasis model assessment of insulin sensitivity values after simultaneous pancreas-kidney transplant (n=89) or kidney transplant alone (n=68), and the results were compared with those in healthy subjects (n=49).
Homeostasis model assessment of beta-cell function values were similar in patients who underwent kidney transplant alone or a simultaneous pancreas-kidney transplant, and were higher than homeostasis model assessment of beta cell function values in healthy subjects. The homeostasis model assessment of insulin sensitivity showed intermediate values for patients who underwent a simultaneous pancreas-kidney transplant and correlated with prednisone dosages (in those who underwent kidney transplant alone) and tacrolimus levels (in patients who underwent a simultaneous pancreas-kidney transplant). Homeostasis model assessment of beta-cell function values correlated with prednisone dosages in both groups and with tacrolimus levels in only those who underwent a simultaneous pancreas-kidney transplant. The body mass index of subjects who underwent kidney transplant alone correlated with both homeostasis model assessment of beta-cell function results and homeostasis model assessment of insulin sensitivity results. A family history of diabetes in subjects who underwent a simultaneous pancreas-kidney transplant correlated with homeostasis model assessment of beta-cell function results and homeostasis model assessment of insulin sensitivity results.
Immunosuppressive regimen and body mass index were linked with reduced insulin sensitivity after kidney transplant. A family history of diabetes was linked with higher values of insulin secretion and lower insulin sensitivity in patients who underwent a simultaneous pancreas-kidney transplant.
我们采用稳态模型评估法来研究同期胰肾联合移植或单纯肾移植后的胰岛素敏感性和分泌情况。在该模型中，空腹血糖和C肽水平用于评估胰岛素敏感性和β细胞功能。
对同期胰肾联合移植（n = 89）或单纯肾移植（n = 68）后的因素（如年龄、性别、种族、移植肾延迟功能）与β细胞功能的稳态模型评估及胰岛素敏感性值的稳态模型评估进行相关性分析，并将结果与健康受试者（n = 49）的结果进行比较。
单纯肾移植或同期胰肾联合移植患者的β细胞功能值的稳态模型评估结果相似，且高于健康受试者的β细胞功能值的稳态模型评估结果。胰岛素敏感性的稳态模型评估显示，同期胰肾联合移植患者的胰岛素敏感性处于中间值，且与泼尼松剂量（在单纯肾移植患者中）和他克莫司水平（在同期胰肾联合移植患者中）相关。两组患者的β细胞功能值的稳态模型评估均与泼尼松剂量相关，仅在同期胰肾联合移植患者中与他克莫司水平相关。单纯肾移植患者的体重指数与β细胞功能结果的稳态模型评估及胰岛素敏感性结果的稳态模型评估均相关。同期胰肾联合移植患者的糖尿病家族史与β细胞功能结果的稳态模型评估及胰岛素敏感性结果的稳态模型评估相关。
免疫抑制方案和体重指数与肾移植后胰岛素敏感性降低有关。糖尿病家族史与同期胰肾联合移植患者较高的胰岛素分泌值和较低的胰岛素敏感性有关。
