Müller-Felber W, Landgraf R, Scheuer R, Wagner S, Reimers C D, Nusser J, Abendroth D, Illner W D, Land W
Department of Internal Medicine, University of Munich, Germany.
Diabetes. 1993 Oct;42(10):1482-6. doi: 10.2337/diab.42.10.1482.
Twenty-seven patients with successful transplantation and a control group of 14 patients with early rejection of the pancreas graft but functioning kidney graft were examined in a prospective study for 3 yr. Before transplantation, all patients had long-standing type I diabetes with advanced secondary complications, including end-stage diabetic nephropathy. After transplantation in the patients of both groups, kidney function was almost normal. Mean HbA1 levels were normal in the group with pancreas graft survival. In the control group, HbA1 levels were, on average, 1.5% higher compared with the group with pancreas survival (P = 0.00005). After 3 yr, the patients with functioning pancreas graft showed fewer symptoms (mean difference 1.0 in a symptom score ranging from 0 to 16, P = 0.004) compared with the control group. No statistically significant difference between both groups concerning clinical signs of polyneuropathy could be observed. In the pancreas and kidney transplantation group, peroneal and median nerve conduction velocities increased 7.2 m/s (P < 0.01) and 3.5 m/s (P < 0.05), respectively, whereas no increase was registered in the control group. The change of median and sural sensory nerve conduction velocities, peroneal and median compound muscle action potentials, and sural and median sensory action potentials was insignificant. In conclusion, although the improvement of clinical symptoms and neurophysiological signs of polyneuropathy was modest in the pancreas and kidney transplantation group, our data suggest that successful pancreas transplantation is able not only to halt the progression of diabetic polyneuropathy but also to improve it to some extent even at a far advanced stage.
在一项前瞻性研究中，对27例移植成功的患者以及14例胰腺移植早期排斥但肾移植功能良好的患者进行了为期3年的检查。移植前，所有患者均患有长期的I型糖尿病，并伴有晚期继发性并发症，包括终末期糖尿病肾病。两组患者移植后，肾功能几乎正常。胰腺移植存活组的平均糖化血红蛋白（HbA1）水平正常。对照组的HbA1水平平均比胰腺存活组高1.5%（P = 0.00005）。3年后，与对照组相比，胰腺移植功能良好的患者症状较少（症状评分范围为0至16，平均差异为1.0，P = 0.004）。两组在多发性神经病的临床体征方面未观察到统计学上的显著差异。在胰腺和肾脏移植组中，腓总神经和正中神经传导速度分别增加了7.2 m/s（P < 0.01）和3.5 m/s（P < 0.05），而对照组未出现增加。正中神经和腓肠感觉神经传导速度、腓总神经和正中复合肌肉动作电位以及腓肠和正中感觉动作电位的变化不显著。总之，尽管胰腺和肾脏移植组中多发性神经病的临床症状和神经生理体征改善不大，但我们的数据表明，成功的胰腺移植不仅能够阻止糖尿病多发性神经病的进展，而且即使在疾病晚期也能在一定程度上改善病情。
