INSULIN SECRETORY PROFILES AND C-PEPTIDE CLEARANCE KINETICS AT 6 MONTHS AND 2 YEARS AFTER KIDNEY-PANCREAS TRANSPLANTATION
INSULIN SECRETORY PROFILES AND C-PEPTIDE CLEARANCE KINETICS AT 6 MONTHS AND 2 YEARS AFTER KIDNEY-PANCREAS TRANSPLANTATION
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DOI：
10.2337/diabetes.41.10.1346
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发表时间：
1992-10-01
期刊：
影响因子：
7.7
通讯作者：
THISTLETHWAITE, JR
中科院分区：
文献类型：
--
作者：
BLACKMAN, JD;POLONSKY, KS;THISTLETHWAITE, JR
葡萄糖，胰岛素分泌，胰岛素分泌脉冲测定外周C-肽浓度的反卷积在10个IDDM受体的肾-胰腺联合移植后6个月，并与10个匹配的非糖尿病对照组进行了比较。10例受者中有7例在移植后2年进行了再研究。为了对照免疫抑制治疗，还研究了6例肾移植患者。胰腺胰岛素分泌率进行了评估，在24小时内与三个混合餐。移植后6个月，对照受试者和受体的空腹（5.3 +/-0.1 vs. 5.3 +/- 0.1 mM）、平均24小时（6.0 +/- 0.1 vs. 5.1 +/- 0.1 mM）和进餐相关（6.1 +/- 0.3 vs. 5.8 +/- 0.2 mM）血糖水平分别没有差异。两组之间的总24小时胰岛素分泌率相似（150 +/- 15 vs. 182 +/- 24 nmol . m-2 24 h-1）。然而，移植后，基础胰岛素分泌和膳食刺激的胰岛素分泌之间的关系随着基础胰岛素分泌的增加而改变（52.2 +/- 6.4 vs. 97.4 +/- 12.5 pmol . m-2 min ~（-1），P < 0.004），并减少与进餐相关的分泌。对照组受试者基础分泌占24小时总胰岛素分泌的比例为44 +/- 4%，而受体受试者为73 +/- 5%。通过脉搏分析确定的每24小时胰岛素分泌的超日振荡次数在对照受试者和受体中相似（11.9 +/- 0.9 vs. 10.4 +/- 0.5振荡/24小时）。移植后两年，葡萄糖曲线和振荡胰岛素分泌模式保持完整。基础胰岛素分泌为76 +/- 11 pmol。m-2 min-1和24小时胰岛素分泌为167 +/- nmol。m-2 24小时6例肾移植受者的研究表明，47 +/- 3%的24小时胰岛素分泌是基础分泌。这一发现支持了这样一种观点，即在肾胰腺受体中观察到的膳食分泌模式改变不是免疫抑制治疗的结果。肾-胰联合移植后，1）移植后2年血糖曲线保持正常，2）C肽清除率降低，3）基础胰岛素分泌增加，但进餐反应降低，4）胰岛素分泌的正常振荡模式持续存在。
Glucose, insulin secretion, and insulin secretory pulses were measured by deconvolution of peripheral C-peptide concentrations in 10 IDDM recipients of a combined kidney-pancreas allograft 6 mo post-transplantation and were compared with 10 matched nondiabetic control subjects. Seven of the 10 recipients were restudied 2 yr post-transplantation. To control for immunosuppressive therapy, 6 patients with a kidney allograft also were studied. Pancreatic insulin secretion rates were evaluated over a 24-h period with three mixed meals. Six months post-transplantation, fasting (5.3 +/- 0.1 vs. 5.3 +/- 0.1 mM), average 24-h (6.0 +/- 0.1 vs. 5.1 +/- 0.1 mM), and meal-related (6.1 +/- 0.3 vs. 5.8 +/- 0.2 mM) plasma glucose levels were not different in control subjects and recipients, respectively. Total 24-h insulin secretion rates were similar between the two groups (150 +/- 15 vs. 182 +/- 24 nmol . m-2 . 24 h-1). However, post-transplantation, the relationship between basal and meal-stimulated insulin secretion was altered with increased basal insulin secretion (52.2 +/- 6.4 vs. 97.4 +/- 12.5 pmol . m-2 . min-1, P < 0.004) and reduced meal-related secretion. The proportion of total 24-h insulin secretion comprised by basal secretion was 44 +/- 4% in the control subjects vs, 73 +/- 5% in recipients. The number of ultradian oscillations of insulin secretion identified in each 24-h period by pulse analysis was similar in control subjects and recipients (11.9 +/- 0.9 vs. 10.4 +/- 0.5 oscillations/24 h). Two years post-transplantation, the glucose profiles and oscillatory insulin secretory patterns remained intact. Basal insulin secretion was 76 +/- 11 pmol . m-2 . min-1 and 24-h insulin secretion was 167 +/- nmol . m-2 . 24 h-1. Six kidney-transplant recipients studied showed that 47 +/- 3% of 24-h insulin secretion was basal secretion. This finding supported the idea that altered meal secretory patterns observed in the kidney-pancreas recipients were not the result of immunosuppressive therapy. After combined kidney-pancreas transplantation 1) plasma glucose profiles remain normal 2 yr post-transplantation, 2) clearance of C-peptide is reduced, 3) basal insulin secretion is increased but meal responses are reduced, and 4) the normal oscillatory pattern of insulin secretion persists.