Madrigal Jessica M, Monson Rebecca S, Hatipoglu Betul, Oberholzer José, Kondos George T, Varady Krista A, Danielson Kirstie K
Division of Transplant Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Division of Epidemiology & Biostatistics, University of Illinois at Chicago, Chicago, IL, USA.
Clin Transplant. 2017 Oct;31(10). doi: 10.1111/ctr.13059. Epub 2017 Aug 19.
Islet cell transplantation can functionally cure type 1 diabetes and also improve carotid intima-media thickness. This study provides a preliminary description of changes in coronary artery calcium following islet transplantation, and associated factors. Coronary artery calcium was measured in 14 patients with type 1 diabetes (11 had measures both pre- and post-transplant [mean 2.3 years]) in the University of Illinois at Chicago's clinical trial. Multivariable mixed-effects linear regression of repeated measures was used to quantify calcium change and determine if this change was longitudinally associated with risk/protective factors. Thirteen of the patients were female, with mean baseline age, diabetes duration, and BMI of 47.6 and 28.7 years, and 23.1, respectively. Over half (57%) had detectable coronary artery calcium pre-transplant. Minimal change (0.39 mm /y, P = .02) occurred in coronary artery calcium levels pre- to post-transplant. No patient met criteria for calcium progression. Coronary artery calcium was positively associated with total and small VLDL particles (P ≤ .02), statin dose (P = .02), and urine albumin-to-creatinine ratio (P = .04) and negatively associated with free fatty acids (P = .03), total HDL (P = .03), large HDL particles (P = .005), and tacrolimus dose (P = .02). Islet transplant may stabilize coronary artery calcium, with optimal management of lipids and kidney function remaining key therapeutic targets. [NCT00679041].
胰岛移植可在功能上治愈1型糖尿病，还能改善颈动脉内膜中层厚度。本研究初步描述了胰岛移植后冠状动脉钙化的变化及相关因素。在伊利诺伊大学芝加哥分校的一项临床试验中，对14例1型糖尿病患者（其中11例在移植前后均有测量[平均2.3年]）的冠状动脉钙化情况进行了测量。采用重复测量的多变量混合效应线性回归来量化钙化变化，并确定这种变化是否与风险/保护因素存在纵向关联。13例患者为女性，平均基线年龄、糖尿病病程和体重指数分别为47.6岁、28.7年和23.1。超过半数（57%）的患者移植前可检测到冠状动脉钙化。移植前后冠状动脉钙化水平变化极小（0.39mm/年，P = 0.02）。没有患者达到钙化进展标准。冠状动脉钙化与总VLDL和小VLDL颗粒（P≤0.02）、他汀类药物剂量（P = 0.02）以及尿白蛋白肌酐比值（P = 0.04）呈正相关，与游离脂肪酸（P = 0.03）、总HDL（P = 0.03）、大HDL颗粒（P = 0.005）以及他克莫司剂量（P = 0.02）呈负相关。胰岛移植可能会使冠状动脉钙化稳定，脂质和肾功能的优化管理仍是关键治疗靶点。[NCT00679041]
