慢性胰腺炎胰岛自体移植后组织病理学、胰岛产量和胰岛移植物功能的相关性。

Correlation of histopathology, islet yield, and islet graft function after islet autotransplantation in chronic pancreatitis.

机构信息

Department of Surgery, University of Minnesota, Minneapolis, MN, USA.

出版信息

Pancreas. 2011 Mar;40(2):193-9. doi: 10.1097/mpa.0b013e3181fa4916.

DOI:10.1097/mpa.0b013e3181fa4916

PMID:21404456

Abstract

OBJECTIVE

The number of islets available (yield) is an important predictor of insulin independence after islet autotransplantation (IAT) done at the time of total pancreatectomy to treat painful chronic pancreatitis. The aim of this study was to correlate histopathologic findings with islet yield and graft function.

METHODS

Pancreatic histopathology was examined in 105 adults who underwent pancreatectomy and IAT; postoperative insulin use was known in 53 cases. Histologic degree of fibrosis, acinar atrophy, inflammation, and nesidioblastosis were scored by a surgical pathologist. The correlation of histopathology with islet yield and graft function was evaluated.

RESULTS

Patients received a median of 2968 islet equivalents per kilogram. Fibrosis and acinar atrophy correlated negatively with islet yield (P < G 0.001, r =0.67), as did inflammation (P < G 0.001, r =0.43). There was a positive correlation of islet yield (P < G 0.0001, r = 0.64) and a negative correlation of fibrosis (P = 0.006, r = 0.43) and acinar atrophy (P = 0.006, r = 0.42) with islet graft function.

CONCLUSION

More severe histopathologic changes were associated with a lower islet yield and lower likelihood of insulin independence. Total pancreatectomy and IAT should not be delayed in patients with painful chronic pancreatitis refractory to medical therapy; otherwise progressive damage to the pancreas may limit islet yield and increase the risk of diabetes.

摘要

目的

胰岛可供数量（产量）是全胰切除术时进行胰岛自体移植（IAT）以治疗慢性胰腺炎疼痛的胰岛素独立性的重要预测因子。本研究的目的是将组织病理学发现与胰岛产量和移植物功能相关联。

方法

对 105 例接受胰切除术和 IAT 的成年人进行胰腺组织病理学检查；53 例病例已知术后胰岛素使用情况。由外科病理学家对纤维化、腺泡萎缩、炎症和胰岛细胞增生程度进行评分。评估组织病理学与胰岛产量和移植物功能的相关性。

结果

患者平均每公斤获得 2968 个胰岛当量。纤维化和腺泡萎缩与胰岛产量呈负相关（P < G 0.001，r =0.67），炎症也是如此（P < G 0.001，r =0.43）。胰岛产量呈正相关（P < G 0.0001，r = 0.64），纤维化（P = 0.006，r = 0.43）和腺泡萎缩（P = 0.006，r = 0.42）与胰岛移植物功能呈负相关。