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​糖尿病治疗新突破！人工胰腺可显著改善儿童血糖水平

2022-02-07 生物探索 网络

儿童1型糖尿病
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1型糖尿病多发于儿童和青少年，疾病的日常监控面临挑战。

糖尿病是一种以高血糖为特征的代谢性疾病，而高血糖持续存在会导致各种器官组织受到损害，尤其是眼、肾、心脏、血管以及神经。目前，糖尿病已经逐渐呈年轻化趋势。其中1型糖尿病（旧称胰岛素依赖型糖尿病）主要是通过免疫介导胰腺β细胞的破坏，从而导致胰岛素的绝对缺乏引起高血糖。
1型糖尿病多发于儿童和青少年，这对于疾病的日常监控来说具有挑战性：首先，胰岛素需求的可变性以及饮食摄入的不确定性；其次，低龄患者对于自身血糖值无法正确判断。目前，在低龄儿童中使用血糖监测设备和胰岛素泵（模拟胰腺的分泌功能，按照人体需要的剂量将胰岛素持续地推注到使用者的皮下，保持全天血糖稳定，以达到控制糖尿病的目的）治疗的方法屡日增加，但是所需费用很高。
近日，有研究团队在国际知名期刊The New England Journal of Medicine（简称NEJM）发表了“混合闭环系统（即人工胰腺）可显著改善患有1型糖尿病儿童的血糖”的研究成果。
 研究成果（图源：NEJM）
研究者们分别在奥地利、德国、卢森堡和英国等七个医学中心招募了正在接受胰岛素泵治疗且年龄介于1至7岁之间的1型糖尿病患者，然后分别统计了患者的年龄、性别、种族以及具体的血糖指标。参与者在为时两个16周的周期间以随机顺序接受治疗，将人工胰腺系统与胰岛素泵治疗（对照）进行了比较。
表1 参与者的初始基本数据
表格来源：NEJM
首先，研究分析中的主要关键点是统计每个周期内葡萄糖测量值处于目标范围（70-180 mg/dL）的时间百分比的治疗差异。根据数据显示，处于高血糖状态（>180 mg/dL）的时间百分比平均调整治疗间差异水平为-8.5%；糖化血红蛋白水平的平均调整治疗间差异水平为-0.4%；使用人工胰腺系统的目标血糖（70-180 mg/dL）的时间百分比与使用胰岛素泵治疗相比而言高8.7%。使用人工胰腺系统的平均葡萄糖水平显著低于胰岛素泵治疗法。也就是说，人工胰腺系统控制血糖在目标范围内的效果较胰岛素泵治疗法相对明显。
表2 人工胰腺系统与胰岛素泵的血糖水平结果
表格来源：NEJM
次要关键点是分析处于高血糖状态的时间百分比（葡萄糖水平>180 mg/dL）、糖化血红蛋白水平、平均葡萄糖水平以及处于低血糖状态的时间百分比（葡萄糖水平<70 mg/dL）。两种治疗方式之间血糖水平低于63 mg/dL 和低于54 mg/dL 的时间百分比没有显着差异。人工胰腺治疗期间处于高血糖状态（>300 mg/dL）的时间百分比比胰岛素泵治疗低1.0%；在低血糖状态下的时间没有区别。并且，儿童在血糖水平升高（高血糖）上的时间不到四分之一（22.9%），比对照组低近9个百分点。
另外，平均而言，使用人工胰腺系统时，儿童一天中约有四分之三的时间（71.6%）在其葡萄糖水平的目标范围内--与对照组相比高出近9个百分点，占每天在目标范围内的额外125分钟。这些数据都进一步说明了人工胰腺治疗的优越性。
表3 人工胰腺和胰岛素泵治疗周期内白天和夜间的血糖水平
表格来源：NEJM
由于胰岛素需求的变异性和夜间发生低血糖的高概率，使得患有1型糖尿病的儿童普遍睡眠质量差。而在本次研究中，研究人员发现使用人工胰腺系统后，80%以上的夜间传感器读数都在目标范围内，这表明人工胰腺系统比胰岛素泵疗法更有效地解决了“夜间问题”。
综上，相比胰岛素泵治疗，人工胰腺治疗显著改善了1型糖尿病儿童的血糖水平，尤其是在夜间控制血糖的稳定有极大的优势。本研究也是第一次证明了该疗法在儿童患者身上有几个月的显著疗效。期待该治疗方法可以惠及更多的糖尿病患者。

 

撰文|郭海君

排版|露娜

End

参考资料：

[1]Ware J, Allen JM, Boughton CK, et al. Randomized Trial of Closed-Loop Control in Very Young Children with Type 1 Diabetes. N Engl J Med. 2022 Jan 20;386(3):209-219. doi: 10.1056/NEJMoa2111673. PMID: 35045227.
 

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    2022-07-27 lsj628

    #血糖水平#

    0

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    2022-09-15 zxxiang

    #新突破#

    0

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    2022-09-10 zhanglin3079

    #糖尿病治疗#

    0

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    2022-02-10 ms3000000637975859

    新突破，新方法

    0

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    2022-02-09 仁医06

    #人工胰腺#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1972069, encodeId=ba3619e2069ba, content=<a href='/topic/show?id=c0fc89839ff' target=_blank style='color:#2F92EE;'>#血糖水平#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89839, encryptionId=c0fc89839ff, topicName=血糖水平)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b73f484, createdName=lsj628, createdTime=Wed Jul 27 09:07:44 CST 2022, time=2022-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1725067, encodeId=f5271e250679d, content=<a href='/topic/show?id=9ee758586bb' target=_blank style='color:#2F92EE;'>#新突破#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58586, encryptionId=9ee758586bb, topicName=新突破)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=792a33728807, createdName=zxxiang, createdTime=Thu Sep 15 06:07:44 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1990004, encodeId=74b01990004c0, content=<a href='/topic/show?id=3207e6735ae' target=_blank style='color:#2F92EE;'>#糖尿病治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76735, encryptionId=3207e6735ae, topicName=糖尿病治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e6a1280, createdName=zhanglin3079, createdTime=Sat Sep 10 01:07:44 CST 2022, time=2022-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1191953, encodeId=3dc2119195395, content=新突破，新方法, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=89ae6481716, createdName=ms3000000637975859, createdTime=Thu Feb 10 18:29:34 CST 2022, time=2022-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1539545, encodeId=99a3153954540, content=<a href='/topic/show?id=46002486293' target=_blank style='color:#2F92EE;'>#人工胰腺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=24862, encryptionId=46002486293, topicName=人工胰腺)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Wed Feb 09 02:07:44 CST 2022, time=2022-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1191162, encodeId=1d351191162bb, content=新发现，值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=89ae6481716, createdName=ms3000000637975859, createdTime=Tue Feb 08 20:04:45 CST 2022, time=2022-02-08, status=1, ipAttribution=)]
    2022-02-08 ms3000000637975859

    新发现，值得学习

    0

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