Kamel Jordan T, Goodman David J, Howe Kathy, Cook Mark J, Ward Glenn M, Roberts Leslie J
Centre for Clinical Neurosciences and Neurological Research, St. Vincent's Hospital Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, Victoria, Australia.
Diabetes Metab Res Rev. 2015 Sep;31(6):646-50. doi: 10.1002/dmrr.2652. Epub 2015 Jun 16.
This study assesses the autonomic function of patients who have regained awareness of hypoglycaemia following islet cell or whole pancreas transplant.
Five patients with type 1 diabetes and either islet cell (four patients) or whole pancreas (one patient) transplant were assessed. These patients were age-matched and gender-matched to five patients with type 1 diabetes without transplant and preserved hypoglycaemia awareness and five healthy control participants without diabetes. All participants underwent (i) a battery of five cardiovascular autonomic function tests, (ii) quantitative sudomotor axonal reflex testing, and (iii) sympathetic skin response testing.
Total recorded hypoglycaemia episodes per month fell from 76 pre-transplant to 13 at 0- to 3-month post-transplant (83% reduction). The percentage of hypoglycaemia episodes that patients were unaware of decreased from 97 to 69% at 0-3 months (p < 0.001, Fisher's exact test) and to 20% after 12 months (p < 0.0001, Fisher's exact test). This amelioration was maintained at the time of testing (mean time: 4.1 years later, range: 2-6 years). Presence of significant autonomic neuropathy was seen in all five transplanted patients (at least 2/3 above modalities abnormal) but in only one of the patients with diabetes without transplantation.
The long-term maintenance of hypoglycaemia awareness that returns after islet cell/pancreas transplantation in patients with diabetes is not prevented by significant autonomic neuropathy and is better accounted for by other factors such as reversal of hypoglycaemia-associated autonomic failure.
本研究评估胰岛细胞或全胰腺移植后恢复低血糖意识的患者的自主神经功能。
对5例1型糖尿病患者进行评估，其中4例接受胰岛细胞移植，1例接受全胰腺移植。这些患者在年龄和性别上与5例未移植且保留低血糖意识的1型糖尿病患者以及5名无糖尿病的健康对照参与者相匹配。所有参与者均接受了以下检查：（i）一系列五项心血管自主神经功能测试；（ii）定量汗腺轴突反射测试；（iii）交感神经皮肤反应测试。
每月记录的低血糖发作总数从移植前的76次降至移植后0至3个月时的13次（减少83%）。患者未意识到的低血糖发作百分比在0至3个月时从97%降至69%（p<0.001，Fisher精确检验），12个月后降至20%（p<0.0001，Fisher精确检验）。这种改善在测试时得以维持（平均时间：4.1年后，范围：2至6年）。所有5例移植患者均存在明显的自主神经病变（至少2/3以上检查项目异常），而未移植的糖尿病患者中只有1例存在。
糖尿病患者胰岛细胞/胰腺移植后恢复的低血糖意识的长期维持不受明显自主神经病变的影响，其他因素如低血糖相关自主神经功能衰竭的逆转对此能做出更好的解释。
