Division of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Bunkyo-Ward, Tokyo, 113-8510, Japan.
Department of Pediatric Oncology, National Cancer Center Hospital, Chuou-Ward, Tokyo, 104-0045, Japan.
Endocrine. 2018 Jul;61(1):76-82. doi: 10.1007/s12020-018-1595-3. Epub 2018 Apr 24.
Hematopoietic stem cell transplantation (HSCT) is a curative treatment for life-threatening malignancies and related diseases. Recently, the long-term prognosis of HSCT during childhood has greatly improved; however, the late adverse effects of HSCT have been found to cause substantial morbidity among long-term survivors. Although metabolic complications, such as diabetes mellitus (DM) and hyperlipidemia (HL), are the major late effects of pediatric HSCT, the clinical details are not clarified sufficiently.
From 1983 to 2013, 75 participants underwent HSCT in our institute because of malignant or other related diseases. We retrospectively evaluated metabolic complications of eligible 22 participants (14 men and 8 women), and their clinical backgrounds.
Among 22 participants, 4 and 9 participants developed DM and HL after HSCT, respectively, and all participants with DM developed HL. None of the participants with DM were obese, and all had substantial insulin resistance. Total body irradiation (TBI) was performed in 10 participants, including 4 participants with DM and 5 participants with HL, revealing that TBI is an independent risk factor for DM. The age at TBI for participants with DM was significantly lower than that for participants without DM (p = 0.01), and all participants with DM received TBI before the age of 6.
Our data suggested that TBI was a risk factor for DM after HSCT, and TBI before the age of six increased the possibility of DM without obesity.
造血干细胞移植（HSCT）是治疗危及生命的恶性肿瘤和相关疾病的一种有治愈可能的疗法。最近，儿童时期 HSCT 的长期预后有了很大的改善；然而，HSCT 的晚期不良影响被发现会导致长期存活者出现大量发病。尽管代谢并发症，如糖尿病（DM）和高脂血症（HL），是儿科 HSCT 的主要晚期效应，但临床细节尚未充分阐明。
1983 年至 2013 年，我院有 75 名参与者因恶性肿瘤或其他相关疾病接受 HSCT。我们回顾性评估了 22 名符合条件的参与者（14 名男性和 8 名女性）的代谢并发症及其临床背景。
在 22 名参与者中，4 名和 9 名参与者分别在 HSCT 后出现 DM 和 HL，所有患有 DM 的参与者均出现 HL。无 DM 参与者肥胖，且均存在明显的胰岛素抵抗。10 名参与者接受了全身照射（TBI），其中 4 名患有 DM，5 名患有 HL，表明 TBI 是 DM 的独立危险因素。患有 DM 的参与者接受 TBI 的年龄明显低于未患有 DM 的参与者（p=0.01），且所有患有 DM 的参与者均在 6 岁之前接受了 TBI。
我们的数据表明，TBI 是 HSCT 后发生 DM 的危险因素，6 岁之前接受 TBI 会增加非肥胖型 DM 的可能性。
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