Dafoe D C, Campbell D A, Rosenberg L, Merion R M, Ucros I, Vinik A I, Klandorf H, Turcotte J G
Department of Internal Medicine and Surgery of Michigan, Ann Arbor.
Transplantation. 1989 Jul;48(1):22-6. doi: 10.1097/00007890-198907000-00006.
The concept of islet exhaustion maintains that exposure of pancreatic islets to hyperglycemia and other stresses leads to islet dysfunction and irreparable damage. The process of pancreatic transplantation places many stresses on islets (e.g., counter-regulatory hormones, steroids, cyclosporine toxicity). As practiced by some centers, it may be important to administer exogenous insulin in the postoperative period to provide islet rest. Using a porcine pancreas transplant model that simulates clinical transplantation, we studied 2 groups: 1 group (n = 8) received constant insulin infusion for 7 days after transplantation; the control group (n = 5) received vehicle only. The islets in the insulin infusion group were rested as evidenced by a significantly decreased mean C-peptide level (0.27 +/- 0.04 ng/ml) as compared to the control group (0.66 +/- 0.08 ng/ml) (P less than 0.05). After insulin infusion was discontinued, intravenous glucose tolerance testing found insulin, C-peptide and glucagon responses were not different between groups. Glucose clearance was also comparable; K values were -1.79 and -1.60 in the insulin infusion and control groups, respectively. In conclusion, islet rest by insulin infusion for 7 postoperative days did not improve subsequent pancreas transplant endocrine function.
胰岛耗竭的概念认为，胰腺胰岛暴露于高血糖和其他应激因素会导致胰岛功能障碍和不可修复的损伤。胰腺移植过程给胰岛带来许多应激（如反调节激素、类固醇、环孢素毒性）。按照一些中心的做法，术后给予外源性胰岛素以让胰岛休息可能很重要。我们使用模拟临床移植的猪胰腺移植模型，研究了2组：一组（n = 8）在移植后持续输注胰岛素7天；对照组（n = 5）仅接受赋形剂。胰岛素输注组的胰岛得到了休息，这表现为与对照组（0.66 +/- 0.08 ng/ml）相比，平均C肽水平显著降低（0.27 +/- 0.04 ng/ml）（P小于0.05）。停止胰岛素输注后，静脉葡萄糖耐量试验发现两组之间的胰岛素、C肽和胰高血糖素反应没有差异。葡萄糖清除率也相当；胰岛素输注组和对照组的K值分别为-1.79和-1.60。总之，术后7天通过胰岛素输注使胰岛休息并不能改善随后的胰腺移植内分泌功能。
