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3．胰岛胰腺移植
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从1974年到1995年底270名1型DM患者在不同国家的31个治疗中心接受了胰岛移植。这些患者中有27名转为NIDDM, 持续时间13d～14年。但胰岛移植仍面临两大问题，一是排斥反应未解决，接受移植者从长期（每日）注射胰岛素变为应用免疫抑制剂；而且人胰岛细胞来源匮乏。对于前者，如不用免疫抑制剂还有两种方法：①诱导供者特异的免疫耐受，或诱导对B细胞的反应的淋巴细胞的凋亡；②免疫隔离（屏障）法可用微囊或大囊包被胰岛细胞，此法可防止淋巴细胞的攻击，但不能防止小分子细胞因子，如IL-I及NO对胰岛细胞的损伤，因这些小分子可以穿越微囊半透膜；再者囊的最佳孔径，囊内胰岛细胞的增殖与死亡不平衡等问题仍有待解决。对于解决供体来源不足的办法主要有：①非人猪胰岛的应用，以猪胰岛异种移植研究较多。以色列的Bloch报告婴猪胰岛较成熟猪胰岛更佳，因其免疫原性较低；②用基因工程细胞系，仿正常B细胞功能。美国德州的Clark等已获得稳定的细胞系，作为移植细胞，已能保持基因型及表型的稳定性。Newgard等也报告了应用RIN细胞系表达人类胰岛基因，其他细胞系表达高水平的GLUT-2和GCK, 将人工细胞移植到裸鼠体内所有的转基因至少表达48d。
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胰肾联合移植对终末期DM有近期疗效。
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【思考题】
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1．试述糖尿病的诊断标准和控制目标。
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2．糖尿病的治疗措施有哪些？
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参考文献
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[2] 胡承，贾伟平．2型糖尿病易感基因定位研究．中华内分泌代谢杂志，2008，2
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[10] Yki-Jarvinen H, Kauppinen-Makelin R, Tiikkainen M, et al. Insulin glargine or NPH combined with metformin in type 2 diabetes: the LANMET study. Diabetologia, 2006, 49
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[11] Green, BD, Flatt, PR & Bailey, CJ. Dipeptidyl peptidase IV inhibitors: a newly emerging drug class for the treatment of type 2 diabetes. Diab Vasc Dis Res, 159-165.
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（童钟杭）
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内科学新进展 第六章 肾脏疾病
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第一节 肾脏疾病慢性进展理论与实践
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摘 要 慢性肾功能衰竭（CRF）发病机理甚为复杂，迄今尚未完全明了。历年来先后提出“尿毒症毒素学说”、“完整肾单位学说”、“矫枉失衡学说”、“肾小球高滤过学说”、“脂质代谢紊乱学说”等等，但没有一种学说能完整解释其全部的发病过程。近年来，随着分子生物学的飞速发展及其在肾脏病领域的应用，加深了人们对慢性肾功能衰竭发病机理的认识，已有的学说不断得到补充和纠正，新的学说不断涌现，特别是逐渐认识了各种生长因子和血管活性物质在慢性肾功能衰竭进展中的作用，使慢性肾功能不全发展过程中的多种变化有了更深入细致的认识。随着慢性肾功能衰竭发病机理的逐渐阐明，延缓慢性肾功能衰竭进展的治疗方法不断完善。
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Abstract The pathogenesis of Chronic renal failure（CRF）is very complicated, and has not yet been fully understood. Over the years the “uremic toxics hypothesis,” “integrity nephron hypothesis”, “trade-off hypothesis”, “glomerular homo-filtration hypothesis”, “lipid metabolism disorder hypothesis”, and so on have been put forward, but none of them can completely explain the whole pathogenesis. In recent years, with the rapid development of molecular biology and its applications in the field of kidney disease, we have understood the pathogenesis of chronic renal failure more deeply, the existent hypothesis has been constantly added and corrected and new theories are emerging. Particularly, with the growing recognition of the various growth factors and vasoactive substances which affect in the progress of chronic renal failure, people have got a more in-depth and detailed understanding of the various changes in the development of chronic renal insufficiency. With the pathogenesis of chronic renal failure being gradually clarified, the treatment that delay the progress of chronic renal failure has been continuously improved.
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