Chudek Jerzy, Kolonko Aureliusz, Ziaja Jacek, Francuz Tomasz, Kamińska Dorota, Owczarek Aleksander J, Kuczera Piotr, Kujawa-Szewieczek Agata, Kusztal Mariusz, Kowalik Adrian P, Bożek-Pająk Dominika, Kluz Joanna, Choręza Piotr, Król Robert, Krajewska Magdalena, Cierpka Lech, Więcek Andrzej
Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, 40-027 Katowice, Poland.
Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, 40-027 Katowice, Poland.
J Clin Med. 2021 Aug 25;10(17):3800. doi: 10.3390/jcm10173800.
It is not fully elucidated whether the restoring of normal glucose metabolism after successful simultaneous pancreas-kidney transplantation (SPK) improves vascular wall morphology and function in type 1 diabetic (T1D) patients. Therefore, we compared arterial stiffness, assessed by pulse wave velocity (PWV), carotid intima-media thickness (IMT), and biomarkers of arterial wall calcification in T1D patients after SPK or kidney transplantation alone (KTA). In 39 SPK and 39 KTA adult patients of similar age, PWV, IMT, circulating matrix metalloproteinases (MMPs) and calcification biomarkers were assessed at median 83 months post transplantation. Additionally, carotid plaques were visualized and semi-qualitatively classified. Although PWV and IMT values were similar, the occurrence of atherosclerotic plaques (51.3 vs. 70.3%, < 0.01) and calcified lesions (35.9 vs. 64.9%, < 0.05) was lower in SPK patients. There were significantly lower concentrations of MMP-1, MMP-2, MMP-3, and osteocalcin in SPK subjects. Among the analyzed biomarkers, only logMMP-1, logMMP-2, and logMMP-3 concentrations were associated with log HbA. Multivariate stepwise backward regression analysis revealed that MMP-1 and MMP-3 variability were explained only by log HbA. Normal glucose metabolism achieved by SPK is followed by the favorable profile of circulating matrix metalloproteinases, which may reflect the vasoprotective effect of pancreas transplantation.
在成功进行同期胰肾联合移植（SPK）后，血糖代谢恢复正常是否能改善1型糖尿病（T1D）患者的血管壁形态和功能，目前尚未完全阐明。因此，我们比较了SPK患者或单纯肾移植（KTA）患者的动脉僵硬度（通过脉搏波速度（PWV）评估）、颈动脉内膜中层厚度（IMT）以及动脉壁钙化生物标志物。在39例年龄相仿的SPK成年患者和39例KTA成年患者中，于移植后中位时间83个月时评估了PWV、IMT、循环基质金属蛋白酶（MMPs）和钙化生物标志物。此外，对颈动脉斑块进行了可视化并进行半定量分类。尽管PWV和IMT值相似，但SPK患者中动脉粥样硬化斑块的发生率（51.3%对70.3%，P<0.01）和钙化病变的发生率（35.9%对64.9%，P<0.05）较低。SPK患者中MMP-1、MMP-2、MMP-3和骨钙素的浓度显著较低。在分析的生物标志物中，只有logMMP-1、logMMP-2和logMMP-3浓度与log HbA相关。多变量逐步向后回归分析显示，MMP-1和MMP-3的变异性仅由log HbA解释。SPK实现的正常血糖代谢伴随着循环基质金属蛋白酶的有利特征，这可能反映了胰腺移植的血管保护作用。
