PDF(Pubmed)
Abstract：
Children with intractable chronic pancreatitis may require total pancreatectomy with islet autotransplantation (TPIAT) for pain relief. The IAT reduces the severity of post- pancreatectomy diabetes. We analyzed 635 mixed meal tolerance tests (MMTT) in 134 children undergoing TPIAT to determine whether superior survival of islet grafts explains higher rates of insulin independence previously reported in young children (n = 52, age 3-11 years) versus adolescents (n = 82, age 12-18 years). For MMTT, children consumed Boost HP and we sampled C-peptide and glucose repeatedly over 2 h. The trajectory of outcomes before and after TPIAT was compared between children and adolescents using data from pre-TPIAT and 3, 6 months, 1, 2, 3, and 4 years post-TPIAT and mixed linear models with a random effect for child. Cox regression was used to analyze time outcomes (e.g., time to first off insulin). Islet mass transplanted, measured as islet equivalents (IEQ), was higher in adolescents (p = .003) but IEQ/kg was higher in young children (p < .001) because of their lower weight. AUC C-peptide in young children increased somewhat over 4 years, but was stable in adolescents (p = .0013). AUC glucose increased more in adolescents over time post-TPIAT (p = .0024). Islet function by AUC C-peptide:AUC glucose ratio was better preserved in young children (p < .001). Adolescents were less likely to wean off insulin (hazard ratio .44 [95% CI .28, .69]). These data support an advantage of young age in islet graft survival after TPIAT. The greater likelihood of insulin independence in young children may be driven by better islet survival after transplant.
摘要：
患有顽固性慢性胰腺炎的儿童可能需要全胰腺切除术和胰岛自体移植（TPIAT）以缓解疼痛。IAT降低了胰腺切除术后糖尿病的严重程度。我们分析了134名接受TPIAT的儿童的635次混合膳食耐受性测试（MMTT），以确定胰岛移植物的高生存率是否解释了先前报道的幼儿（n=52，3-11岁）与青少年（n=82，12-18岁）的胰岛素独立率更高。对于MMTT，儿童服用BoostHP，我们在2小时内反复采样C肽和葡萄糖。使用TPIAT前和3、6个月的数据，比较儿童和青少年之间TPIAT前后的结果轨迹。TPIAT后1、2、3和4年以及对儿童具有随机效应的混合线性模型。Cox回归用于分析时间结果(例如，第一次离开胰岛素的时间)。胰岛块移植，以胰岛当量(IEQ)测量，青少年的IEQ/kg较高（p=.003），但幼儿的IEQ/kg较高（p<.001），因为他们的体重较低。儿童的AUCC肽在4年以上有所增加，但在青少年中稳定（p=.0013）。在TPIAT后，随着时间的推移，青少年的AUC葡萄糖增加更多（p=.0024）。通过AUCC-肽：AUC葡萄糖比率在幼儿中更好地保留了胰岛功能（p<.001）。青少年戒断胰岛素的可能性较小（危险比.44[95%CI.28，.69]）。这些数据支持TPIAT后胰岛移植物存活的年轻优势。幼儿胰岛素独立的可能性更大可能是由于移植后胰岛存活率更好。
