Bagdade J D, Ritter M C, Kitabchi A E, Huss E, Thistlethwaite R, Gabfr O, Lambeth H
Department of Medicine, Rush Medical College, Chicago, Illinois, USA.
Diabetes Care. 1996 Oct;19(10):1108-12. doi: 10.2337/diacare.19.10.1108.
Cholesteryl ester transfer (CET) is accelerated in patients with IDDM treated with conventional (subcutaneous) insulin therapy (CIT) and a number of other disorders associated with premature cardiovascular disease. We have shown that in IDDM this disturbance is closely linked to iatrogenic hyperinsulinemia (HI), because it was reversed when insulin was administered by the intraportal (i.p.) route. In this study, we sought to determine whether HI after successful pancreas-kidney transplantation (PKT) has the same adverse effect on CET.
CET was measured by both mass and isotopic assays and compared in two groups of euglycemic non-insulin-requiring IDDM PKT patients with either systemically draining allografts and persistent HI or grafts with portal vein anastomoses that were normoinsulinemic (PK-P). A third group of eight nondiabetic kidney transplant (KT) patients receiving the same immunosuppressive drugs served as control subjects.
CET in pancreas-kidney transplantation subjects with systemic venous drainage (PK-S) was increased (P < 0.001) to the same level we have reported previously in IDDM patients receiving CIT and was significantly higher (P < 0.001) than in those subjects with PK-P. CET in the PK-P group did not differ from that of the KT control patients.
CET is affected by variations in systemic insulin levels in pancreas transplant patients with allografts that have differing venous drainage. Because high systemic insulin levels are linked to the activation of (ET, euglycemic HI IDDM pancreas allograft recipients may continue to be at high risk for macrovascular complications.
在接受常规（皮下）胰岛素治疗（CIT）的胰岛素依赖型糖尿病（IDDM）患者以及其他一些与早发性心血管疾病相关的病症中，胆固醇酯转运（CET）会加速。我们已经表明，在IDDM中，这种紊乱与医源性高胰岛素血症（HI）密切相关，因为当通过门静脉内（i.p.）途径给药胰岛素时，这种紊乱会得到逆转。在本研究中，我们试图确定成功进行胰肾联合移植（PKT）后的HI对CET是否具有相同的不良影响。
通过质量测定和同位素测定来测量CET，并在两组血糖正常且无需胰岛素治疗的IDDM PKT患者中进行比较，一组患者的同种异体移植物通过全身引流且存在持续性HI，另一组患者的移植物进行门静脉吻合且胰岛素水平正常（PK-P）。第三组八名接受相同免疫抑制药物治疗的非糖尿病肾移植（KT）患者作为对照。
具有全身静脉引流的胰肾联合移植患者（PK-S）的CET增加（P < 0.001）至我们先前报道的接受CIT治疗IDDM患者的相同水平，并且显著高于（P < 0.001）PK-P组的患者。PK-P组的CET与KT对照患者的CET没有差异。
在具有不同静脉引流的同种异体移植物的胰腺移植患者中，CET受全身胰岛素水平变化的影响。由于高全身胰岛素水平与（ET，血糖正常的HI IDDM胰腺同种异体移植受者可能继续处于发生大血管并发症的高风险中。（注：原文中“(ET, euglycemic HI IDDM pancreas allograft recipients may continue to be at high risk for macrovascular complications.”这部分表述似乎存在不完整或错误，翻译时尽量忠实原文）
