EFFECTS OF PANCREATIC TRANSPLANTATION ON DIABETIC NEUROPATHY
EFFECTS OF PANCREATIC TRANSPLANTATION ON DIABETIC NEUROPATHY
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DOI：
10.1056/nejm199004123221503
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发表时间：
1990-04-12
影响因子：
158.5
通讯作者：
NAJARIAN, JS
中科院分区：
文献类型：
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作者：
KENNEDY, WR;NAVARRO, X;NAJARIAN, JS
通过成功移植胰腺重建正常血糖状态可能会阻止或逆转糖尿病神经病变。为了验证这种可能性，我们通过临床检查、神经传导研究和神经功能测试对胰岛素依赖型糖尿病患者在成功的胰腺移植前后的神经功能进行了评估。61例患者在移植前和移植后12个月进行了研究，27例在24个月后再次进行研究，11例在42个月后再次进行研究。一组接受胰岛素治疗的I型糖尿病患者在相似的时间间隔接受了相同的研究- 48名患者在12个月之前和之后，21名患者在24个月后再次接受研究，12名患者在42个月后再次接受研究。在对照组中，神经病变在随访期间有恶化的趋势。临床检查的评分表明12个月后损伤加重。外周运动神经、感觉神经和自主神经功能的神经生理学检测发现异常程度的综合指数表明12个月后自主神经功能下降。在随访24个月和42个月的患者中，检查评分和三个指数值略有恶化，但不显著。相比之下，接受胰腺移植的患者，神经病变倾向于改善。移植后12个月，运动和感觉指数显著改善，移植后24个月，感觉指数显著改善。其他指标略有改善，但在这些时候并不显着，因为在移植后42个月研究的患者中所有四项指标都有改善。我们的结论是，糖尿病性多发性神经病的进展可能会停止通过恢复正常血糖状态成功的胰腺移植。
Reestablishment of the euglycemic state by successful transplantation of the pancreas might halt or reverse diabetic neuropathy. To test this possibility we evaluated neurologic function by clinical examination, nerve conduction studies, and autonomic-function tests in patients with insulin-dependent (Type I) diabetes mellitus before and after successful pancreatic transplantation. Sixty-one patients were studied before and 12 months after transplantation, 27 again after 24 months, and 11 again after 42 months. A control group of patients with Type I diabetes treated with insulin underwent the same studies at similar intervals - 48 patients before and after 12 months had elapsed, 21 again after 24 months, and 12 again after 42 months. In the control group, neuropathy tended to worsen during the follow-up period. The scores on the clinical examination indicated increased impairment after 12 months. Composite indexes of the degree of abnormality found on neurophysiologic testing of the function of peripheral motor, sensory, and autonomic nerves indicated decreased autonomic function after 12 months. The examination score and the three index values worsened slightly but not significantly in the patients followed for 24 and 42 months. In contrast, in the patients who had received pancreatic transplants, the neuropathy tended to improve. There was significant improvement in the motor and sensory indexes 12 months after transplantation and in the sensory index 24 months after transplantation. The other measures improved slightly but not significantly at these times, as did all four measures in the patients studied 42 months after transplantation. We conclude that the progression of diabetic polyneuropathy may be halted through the restoration of a euglycemic state by successful pancreatic transplantation.