Robertson R P, Franklin G, Nelson L
Department of Medicine, University of Minnesota, Minneapolis 55455.
Diabetes. 1989 Jan;38(1):58-64. doi: 10.2337/diab.38.1.58.
Cyclosporin is an immunosuppressive drug used with increasing frequency in patients with diabetes mellitus both as experimental primary therapy for insulin-dependent diabetes mellitus and as therapy accompanying pancreatic transplantation. However, reports have appeared contending that cyclosporin causes glucose intolerance and inhibits pancreatic islet beta-cell function. Consequently, concern has been raised that the beneficial effects of immunosuppression may be offset by adverse metabolic effects of the drug. To address this issue, we examined intravenous glucose tolerance and pancreatic islet beta-cell function in a group of nondiabetic multiple sclerosis patients before and during a 2-yr course of cyclosporin or placebo therapy. Patients were randomly assigned to one of the two drug groups and followed in a double-blind manner. Basal levels of glucose, insulin, and C-peptide as well as glucose disappearance rates and pancreatic islet beta-cell function after stimulation with intravenous glucose and arginine were determined immediately before therapy and after 3 wk, 6 mo, 1 yr, and 2 yr of therapy. No abnormalities in these parameters were observed in the cyclosporin of the placebo-treated group. It appears that cyclosporin can be give in conventional doses for as long as 2 yr without encountering evidence for impaired glucose homeostasis. However, whether adverse effects will materialize over longer periods of drug use remains a question.
环孢素是一种免疫抑制药物，在糖尿病患者中的使用频率日益增加，既作为胰岛素依赖型糖尿病的实验性初始治疗药物，也作为胰腺移植的伴随治疗药物。然而，有报告称环孢素会导致葡萄糖不耐受并抑制胰岛β细胞功能。因此，人们担心免疫抑制的有益效果可能会被该药物的不良代谢作用所抵消。为解决这一问题，我们在一组非糖尿病性多发性硬化症患者中，于环孢素或安慰剂治疗的2年疗程之前及期间，检测了静脉葡萄糖耐量和胰岛β细胞功能。患者被随机分配到两个药物组之一，并以双盲方式进行随访。在治疗前以及治疗3周、6个月、1年和2年后，立即测定葡萄糖、胰岛素和C肽的基础水平，以及静脉注射葡萄糖和精氨酸刺激后的葡萄糖消失率和胰岛β细胞功能。在接受安慰剂治疗组的环孢素治疗过程中，未观察到这些参数有异常情况。看来，环孢素可以常规剂量给药长达2年，而不会出现葡萄糖稳态受损的迹象。然而，在更长时间的用药过程中是否会出现不良反应仍是一个问题。
