Wang Q, Klein R, Moss S E, Klein B E, Hoyer C, Burke K, Sollinger H W
Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison.
Ophthalmology. 1994 Jun;101(6):1071-6. doi: 10.1016/s0161-6420(94)31216-4.
To evaluate the impact of combined kidney and pancreas transplantation on the progression of advanced diabetic retinopathy.
The changes in diabetic retinopathy severity in patients with insulin-dependent diabetes mellitus who had kidney-pancreas transplantation (n = 51) and in those who had kidney transplantation only (n = 21) were compared. Patients were invited to baseline and 1 year follow-up examinations. Fundus photographs were graded in a masked fashion using standardized protocols.
The mean age and duration of diabetes were similar for both groups. After combined transplantation, none of the patients used insulin, and their mean glycosylated hemoglobin was significantly lower (6.4% versus 10.6%) than those who underwent only kidney transplantation. There was a nonsignificant difference in overall progression of retinopathy for combined transplantation compared with kidney transplantation only (risk ratio = 0.73; 95% confidence interval, 0.31, 1.71).
The authors found no evidence that the normalization of glycemia associated with a combined kidney-pancreas transplantation in patients with advanced proliferative diabetic retinopathy (mostly treated with photocoagulation) accelerated retinopathy progression. These data suggest that the normalization of glycemia associated with a combined kidney-pancreas transplantation does not have beneficial influence on the progression of advanced diabetic retinopathy.
评估肾胰联合移植对晚期糖尿病视网膜病变进展的影响。
比较接受肾胰联合移植的胰岛素依赖型糖尿病患者（n = 51）和仅接受肾移植的患者（n = 21）糖尿病视网膜病变严重程度的变化。邀请患者进行基线检查和1年随访检查。使用标准化方案以盲法对眼底照片进行分级。
两组患者的平均年龄和糖尿病病程相似。联合移植后，所有患者均不再使用胰岛素，且其平均糖化血红蛋白水平显著低于仅接受肾移植的患者（6.4% 对10.6%）。与仅进行肾移植相比，联合移植患者视网膜病变的总体进展无显著差异（风险比 = 0.73；95% 置信区间，0.31, 1.71）。
作者未发现证据表明，对于晚期增殖性糖尿病视网膜病变（大多接受光凝治疗）患者，肾胰联合移植带来的血糖正常化会加速视网膜病变进展。这些数据表明，肾胰联合移植带来的血糖正常化对晚期糖尿病视网膜病变的进展没有有益影响。
