背景:胰岛移植治疗1型糖尿病(T1DM)可有效抑制严重低血糖发作(SHE)和恢复血糖调节,这两者都是提高健康相关生活质量(HRQoL)的关键。因此,为了更好地了解胰岛移植的益处,需要对详细说明HRQoL结局的报告进行系统评估.为此,我们对文献进行了系统回顾,以评估胰岛移植对T1DM患者HRQoL的影响,无论是作为独立手术(ITA)还是肾移植(IAK)。
方法:纳入所有提供ITA或IAK后HRQoL定量评估的研究。选定的研究必须满足以下标准:他们必须(i)涉及T1DM的胰岛移植物的成年接受者,(Ii)使用通用或特定疾病的QoL评估工具,(iii)提供移植前和移植后状态之间或移植后状态与其他移植前患者或普通人群之间的QoL度量的比较分析。
结果:符合纳入标准的7项研究提供了205名受试者的数据。在纳入的研究中,使用两种通用仪器测量HRQoL,如36项简式健康调查(SF-36)和健康状况问卷(HSQ)2.0,以及针对疾病的工具,如糖尿病困扰量表(DDS),糖尿病生活质量问卷,和低血糖恐惧调查(HFS)。这些仪器涵盖物理,心理,社会,或功能健康维度。我们发现,与移植前基线相比,胰岛移植与所有HRQoL维度的改善有关。
结论:我们的系统评价表明,胰岛移植可显著提高患有SHE的T1DM患者的生活质量。据我们所知,这是迄今为止进行的最广泛的系统审查,评价胰岛移植对HRQoL的影响。
BACKGROUND: Pancreatic islet
transplantation for type 1 diabetes mellitus (T1DM) is efficacious in supressing severe hypoglycaemic episodes (SHE) and restoring glycaemic regulation, which are both pivotal in increasing health-related quality of life (HRQoL). Therefore, a systematic assessment of reports detailing HRQoL outcomes is warranted to better understand the benefits of islet transplantation. To this end, we performed a systematic
review of the literature to assess the impact of islet
transplantation on HRQoL in individuals with T1DM, whether as a standalone procedure (ITA) or following renal transplantation (IAK).
METHODS: All studies providing a quantitative assessment of HRQoL following ITA or IAK were included. Selected studies had to meet the following criteria: they had to (i) involve adult recipients of islet grafts for T1DM, (ii) use either generic or disease-specific QoL assessment tools, (iii) provide a comparative analysis of QoL metrics between the pre- and post-transplantation state or between the post-transplantation state and other pre-transplant patients or the general population.
RESULTS: Seven studies that met the inclusion criteria provided data on 205 subjects. In the included studies, HRQoL was measured using both generic instruments, such as the 36-item Short Form Health Survey (SF-36) and the Health Status Questionnaire (HSQ) 2.0, and disease-specific instruments, such as the Diabetes Distress Scale (DDS), the Diabetes Quality of Life Questionnaire, and the Hypoglycaemia Fear Survey (HFS). These instruments cover physical, mental, social, or functional health dimensions. We found that pancreatic islet transplantation was associated with improvements in all HRQoL dimensions compared with the pre-transplant baseline.
CONCLUSIONS: Our systematic
review demonstrates that islet
transplantation significantly enhances quality of life in individuals with T1DM who are experiencing SHE. To our knowledge, this is the most extensive systematic
review conducted to date, evaluating the impact of islet
transplantation on HRQoL.