Predicting islet yield in pediatric patients undergoing pancreatectomy and autoislet transplantation for chronic pancreatitis.
Predicting islet yield in pediatric patients undergoing pancreatectomy and autoislet transplantation for chronic pancreatitis.
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DOI：
10.1111/j.1399-5448.2009.00575.x
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发表时间：
2010-06
影响因子：
3.4
通讯作者：
Moran A
中科院分区：
文献类型：
--
作者：
Bellin MD;Blondet JJ;Beilman GJ;Dunn TB;Balamurugan AN;Thomas W;Sutherland DE;Moran A
儿童慢性胰腺炎（CP）与显著的发病率相关，并可导致麻醉剂依赖。全胰腺切除术（TP）可能适用于难治性CP以缓解疼痛;同时胰岛自体移植（IAT）可能预防术后糖尿病。大约一半的儿科患者在IAT后1年胰岛素不依赖。胰岛素依赖性与可用于移植的胰岛数量（胰岛产量）相关性最好。目前还没有已知的方法来预测给定患者的胰岛产量。我们评估了10名接受TP/IAT的儿童术前代谢试验预测胰岛产量的能力。10例年龄≤ 18岁的患者术前进行了血红蛋白A1c（HbA1c）和混合餐耐量试验（MMTT）。空腹血糖、C肽和肌酐用于计算C肽与葡萄糖 * 肌酐比值（CPGCR）。从2 h MMTT测定C肽峰和曲线下面积（AUC）。进行线性回归以从基线测试结果预测胰岛产量。胰岛产量为7000~434000个胰岛当量（IE），平均222452 ± 148697IE。从体重和空腹血糖可以很好地预测胰岛产量（R2 = 57%，通过自举法调整过拟合）。胰岛产量与CPGCR、峰值C肽和AUC C肽呈正相关，与HbA1c呈负相关。来自10名儿科患者的初步数据表明，术前简单测量空腹血糖可能有助于预测胰岛产量。胰岛产量与HbA1c和C肽水平相关。这些信息允许个体候选人权衡成为糖尿病的特定风险与疼痛缓解的益处，如果他们接受TP-IAT。
Chronic pancreatitis (CP) in children is associated with significant morbidity and can lead to narcotic dependence. Total pancreatectomy (TP) may be indicated in refractory CP to relieve pain; simultaneous islet autotransplant (IAT) may prevent postsurgical diabetes. About half of pediatric patients are insulin independent 1 yr after IAT. Insulin independence correlates best with the number of islets available for transplantation (islet yield). Currently there is no known method to predict islet yield in a given patient. We assessed the ability of preoperative metabolic tests to predict islet yields in 10 children undergoing TP/IAT. Hemoglobin A1c (HbA1c) and mixed meal tolerance tests (MMTT) were obtained prior to surgery in 10 patients age ≤ 18 yr. Fasting glucose, C-peptide, and creatinine were used to calculate the C-peptide to glucose* creatinine ratio (CPGCR). C-peptide peak and area under the curve (AUC) were determined from 2 h MMTT. Linear regressions were performed to predict islet yield from baseline test results. Islet yield ranged from 7000 to 434 000 islet equivalents (IE) (mean 222 452 ± 148 697 IE). Islet yield was well predicted from body weight and fasting plasma glucose (R2 = 57%, adjusted for overfitting by bootstrap). Islet yield was positively associated with CPGCR, peak C-peptide, and AUC C-peptide and negatively associated with HbA1c. Pilot data from 10 pediatric patients suggest that simple preoperative measurement of fasting plasma glucose may give a useful prediction of islet yield. Islet yield correlates with HbA1c and C-peptide levels. This information allows individual candidates to weigh the specific risk of becoming diabetic against the benefit of pain relief should they undergo TP-IAT.
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DOI：
10.1097/mpg.0b013e31815cbaf9
发表时间：
2008-07-01
影响因子：
2.9
作者：
Bellin, Melena D.;Carlson, Annelisa M.;Sutherland, David E. R.
通讯作者：
Sutherland, David E. R.
DOI：
10.1007/bf02581331
发表时间：
1990-07-01
期刊：
ACTA DIABETOLOGICA LATINA
影响因子：
--
作者：
RICORDI, C;GRAY, DWR;LACY, PE
通讯作者：
LACY, PE
影响因子：
--
作者：
Lowe, Mark E
通讯作者：
Lowe, Mark E
影响因子：
3.3
作者：
Lakey, JRT;Warnock, GL;Rajotte, RV
通讯作者：
Rajotte, RV
影响因子：
8.8
作者：
Hering, BJ;Kandaswamy, R;Bluestone, JA
通讯作者：
Bluestone, JA