Elmer D S, Hathaway D K, Bashar Abdulkarim A, Hughes T A, Shokouh-Amiri H, Gaber L W, Gaber A O
Department of Surgery, The University of Tennessee, Memphis 38163, USA.
Clin Transplant. 1998 Feb;12(1):56-64.
We have reported that a decline in glucose disappearance rate (kG) in pancreas transplant recipients is associated with pancreatic rejection. The purpose of this study was to determine test-retest reliability of kG monitoring and to establish the kG criteria for diagnosing abnormal graft function. Six healthy non-diabetic volunteers and 14 stable pancreas recipients underwent 2 intravenous glucose tolerance tests 7 d apart. All kG values in non-diabetic volunteers had < 15% variation between the two determinations (r = 0.96, P < or = 0.0006). Similarly, 13/14 recipients experienced < 20% variation in kG with one patients experiencing a 23% variation (r = 0.90, P < or = 0.0001). Using a 20% change from baseline as the reference value, we monitored 28 pancreas recipients for 2-36 months post-transplant. Of 253 kG values, 160 (64%) did not exceed the 20% change from baseline, 65 (26%) declined > 20% and 28 (11%) increased > 20%. Of 160 stable kG values, 154 (96%) were associated with normal graft function while 6 (4%) occurred in the context of rejection. Of 65 kG values declining by > or = 20%, 47 (72%) accurately identified acute rejections diagnosed by biopsy (70%) or response to treatment (30%), 12 (19%) were associated with identifiable causes of increased insulin resistance and only in 6 (9%) cases a cause for the decline was unidentifiable. The kG values with > 20% rise from baseline were, in 15%, associated with identifiable causes of decreased insulin resistance. The sensitivity of the kG as a marker for rejection was 88.7%, specificity 91%, positive predictive value 72.3%, negative predictive value 96.8%, and accuracy 90.5%. These data confirm that a > 20% deterioration of glucose disappearance rate is associated with pancreas allograft rejection, and confirms the utility of kG monitoring in clinical follow-up of pancreas transplant recipients.
我们曾报道，胰腺移植受者的葡萄糖消失率（kG）下降与胰腺排斥反应相关。本研究的目的是确定kG监测的重测可靠性，并建立诊断移植胰腺功能异常的kG标准。6名健康非糖尿病志愿者和14名稳定的胰腺移植受者接受了间隔7天的两次静脉葡萄糖耐量试验。非糖尿病志愿者的所有kG值在两次测定之间的差异<15%（r = 0.96，P≤0.0006）。同样，14名受者中有13名的kG差异<20%，1名患者的差异为23%（r = 0.90，P≤0.0001）。以较基线变化20%作为参考值，我们对28名胰腺移植受者进行了移植后2至36个月的监测。在253个kG值中，160个（64%）未超过较基线变化20%，65个（26%）下降>20%，28个（11%）升高>20%。在160个稳定的kG值中，154个（96%）与移植胰腺功能正常相关，6个（4%）出现在排斥反应的情况下。在65个下降≥20%的kG值中，47个（72%）准确识别出经活检诊断（70%）或对治疗有反应（30%）的急性排斥反应，12个（19%）与胰岛素抵抗增加的可识别原因相关，仅6个（9%）病例中下降原因无法识别。较基线升高>20%的kG值中，15%与胰岛素抵抗降低的可识别原因相关。kG作为排斥反应标志物的敏感性为88.7%，特异性为91%，阳性预测值为72.3%，阴性预测值为96.8%，准确性为90.5%。这些数据证实，葡萄糖消失率恶化>20%与胰腺移植排斥反应相关，并证实了kG监测在胰腺移植受者临床随访中的实用性。
