ADA 2014：非清髓性自体造血干细胞移植(AHSCT)治疗新发1型糖尿病(T1DM) 中国研究撑起半壁江山

2014-06-19 MedSci MedSci原创

D'addio报告了基于全球3项研究[波兰华沙医科大学(n=24)、我国南京鼓楼医院朱大龙教授研究组(n=13)、上海瑞金医院宁光教授研究组(n=28)]的综述，反映了国际非清髓性自体造血干细胞移植(AHSCT)治疗新发1型糖尿病(T1D)的当前经验。研究者使用环磷酰胺和抗胸腺细胞球蛋白(ATG)对患者进行非清髓性预处理后，将预先采集冻存的造血干细胞(HSC)回输，随访48个月。在治疗后6个月，

D'addio报告了基于全球3项研究[波兰华沙医科大学(n=24)、我国南京鼓楼医院朱大龙教授研究组(n=13)、上海瑞金医院宁光教授研究组(n=28)]的综述，反映了国际非清髓性自体造血干细胞移植(AHSCT)治疗新发1型糖尿病(T1D)的当前经验。

研究者使用环磷酰胺和抗胸腺细胞球蛋白(ATG)对患者进行非清髓性预处理后，将预先采集冻存的造血干细胞(HSC)回输，随访48个月。在治疗后6个月，59%的患者停用胰岛素;在随访结束时，仍有32%的患者维持不用胰岛素;对治疗有反应的患者血糖代谢状态和β细胞功能改善。不良反应发生率较高，提示AHSCT应用于严格选择的患者，并需要开发基于HSC、更安全的治疗。

专家评论

朱大龙教授在接受记者现场采访时谈到，AHSCT治疗T1D全球仍处于探索阶段，目前有较详细资料可查的只有4个中心(巴西、波兰、南京鼓楼医院、上海瑞金医院)。由于AHSCT需要免疫清除，患者耐受性和接受度较差，鼓楼医院近年已改作一级亲属骨髓间充质干细胞移植或脐血间充质干细胞移植。间充质干细胞免疫原性低，不需做免疫清除，且对早期患者免疫调节功能更好，一旦技术成熟，将取代AHSCT。我国实践经验表明，多数患者胰岛素减量、血糖波动减少，且安全性良好，迄今未发生严重不良反应。远期随访则要注意肿瘤发生率是否增加。

相关文献：
Gu W, Hu J, Wang W, Li L, Tang W, Sun S, Cui W, Ye L, Zhang Y, Hong J, Zhu D, Ning G.Diabetic ketoacidosis at diagnosis influences complete remission after treatment with hematopoietic stem cell transplantation in adolescents with type 1 diabetes.Diabetes Care. 2012 Jul;35(7):1413-9.

Li L, Shen S, Ouyang J, Hu Y, Hu L, Cui W, Zhang N, Zhuge YZ, Chen B, Xu J, Zhu D.Autologous hematopoietic stem cell transplantation modulates immunocompetent cells and improves β-cell function in Chinese patients with new onset of type 1 diabetes.J Clin Endocrinol Metab. 2012 May;97(5):1729-36

de Oliveira GL, Malmegrim KC, Ferreira AF, Tognon R, Kashima S, Couri CE, Covas DT, Voltarelli JC, de Castro FA.Up-regulation of fas and fasL pro-apoptotic genes expression in type 1 diabetes patients after autologous haematopoietic stem cell transplantation.Clin Exp Immunol. 2012 Jun;168(3):291-302.

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2014-10-15 limedical1982

#细胞移植#

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2015-04-11 x35042875

国真实妊娠糖尿病患病率应该在这两种方案得到的患病率之间

165 0
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encryptionId=8a8d1e03926, topicName=T1D)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=677711243794, createdName=huhuaidong391, createdTime=Sat Jun 21 13:19:00 CST 2014, time=2014-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534993, encodeId=3ac01534993c0, content=<a href='/topic/show?id=f92a8602447' target=_blank style='color:#2F92EE;'>#自体造血干细胞移植#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86024, encryptionId=f92a8602447, topicName=自体造血干细胞移植)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=02d712580056, createdName=dongjia2014, createdTime=Sat Jun 21 13:19:00 CST 2014, time=2014-06-21, status=1, ipAttribution=)]
2014-11-20 sjq035

#HSC#

42 0
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createdTime=Sat Apr 11 23:41:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1658581, encodeId=76a5165858173, content=<a href='/topic/show?id=4d06914052' target=_blank style='color:#2F92EE;'>#HSC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9140, encryptionId=4d06914052, topicName=HSC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4bd24890262, createdName=sjq035, createdTime=Thu Nov 20 02:19:00 CST 2014, time=2014-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264515, encodeId=37c11264515fa, content=<a href='/topic/show?id=150f19229c' target=_blank style='color:#2F92EE;'>#ADA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1922, encryptionId=150f19229c, topicName=ADA)], 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2014-06-21 医者仁心

#ADA#

26 0
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encryptionId=8a8d1e03926, topicName=T1D)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=677711243794, createdName=huhuaidong391, createdTime=Sat Jun 21 13:19:00 CST 2014, time=2014-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534993, encodeId=3ac01534993c0, content=<a href='/topic/show?id=f92a8602447' target=_blank style='color:#2F92EE;'>#自体造血干细胞移植#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86024, encryptionId=f92a8602447, topicName=自体造血干细胞移植)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=02d712580056, createdName=dongjia2014, createdTime=Sat Jun 21 13:19:00 CST 2014, time=2014-06-21, status=1, ipAttribution=)]
2014-06-21 zhaojie88

#造血干细胞#

32 0
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2014-06-21 ms6980045490879608

#T1DM#

34 0
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2014-06-21 俅侠

#造血#

28 0
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2014-06-21 zhouqu_8

#髓性#

29 0
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2014-06-21 huhuaidong391

#T1D#

40 0
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encryptionId=8a8d1e03926, topicName=T1D)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=677711243794, createdName=huhuaidong391, createdTime=Sat Jun 21 13:19:00 CST 2014, time=2014-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534993, encodeId=3ac01534993c0, content=<a href='/topic/show?id=f92a8602447' target=_blank style='color:#2F92EE;'>#自体造血干细胞移植#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86024, encryptionId=f92a8602447, topicName=自体造血干细胞移植)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=02d712580056, createdName=dongjia2014, createdTime=Sat Jun 21 13:19:00 CST 2014, time=2014-06-21, status=1, ipAttribution=)]
2014-06-21 dongjia2014

#自体造血干细胞移植#

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ADA 2014：非清髓性自体造血干细胞移植(AHSCT)治疗新发1型糖尿病(T1DM) 中国研究撑起半壁江山

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