Diabetes Treatment Disappoints in New Study
細胞移植法治療糖尿病遭遇尷尬

　　The cell transplants did free patients from insulin shots， but only temporarily： within two years， 86 percent needed insulin again， according to a report to be published Thursday in The New England Journal of Medicine.

　　星期四刊登在《新英格蘭醫(yī)學(xué)雜志》上的報告顯示，細胞移植的確免除了患者注射胰島素之苦，但是作用卻只是暫時的：86%的患者在2年以內(nèi)再次需要新的胰島素。

　　The patients had severe Type 1 diabetes， also called juvenile diabetes， in which the body lacks insulin and people must inject it several times a day to control blood sugar. They were given islet cells from the pancreas of a dead organ donor.

　　患有嚴重的Ⅰ型糖尿病，也稱為青少年糖尿病的患者體內(nèi)缺少胰島素，為了控制血糖必須每天多次注射胰島素。他們被移植了死亡的器官捐獻者的胰臟細胞。

　　The transplants do not require major surgery， just a tube inserted into a vein in the abdomen so that the cells can be dripped into the liver， where they take up residence in tiny blood vessels. Because the transplanted cells come from someone else， recipients must take immune-suppressing drugs for life to prevent rejection.

　　移植手術(shù)不需要動大手術(shù)，只需要在患者腹部的血管中插入一個導(dǎo)管把細胞倒入患者的肝臟，細胞就依附在肝臟細小的血管上。因為細胞來自于別人體內(nèi)，接受移植的患者必須終生服用免疫抑制藥物，預(yù)防產(chǎn)生排異現(xiàn)象。

　　The study， involving 36 patients at nine centers in the United States， Canada and Europe， was inspired by a smaller trial published in 2000 that sparked excitement about a transplant technique called the Edmonton protocol， developed at the University of Alberta. In that initial test， none of the patients needed insulin shots-but when the report was published， none had been followed for more than 14 months. Later， many did need the shots again.

　　這項研究是在來自于美國、加拿大和歐洲9個中心的36名患者身上進行的。研究受到2000年發(fā)布的一項小規(guī)模的試驗結(jié)果的啟發(fā)，那一試驗提出了讓人興奮的移植技術(shù)，即在埃爾伯塔大學(xué)發(fā)展起來的埃德蒙頓方案。在起初的試驗中，沒有一個患者需要注射胰島素。醫(yī)學(xué)教.育網(wǎng)搜集但是到試驗報告發(fā)布的時候，所有的病人跟蹤觀察還不到14個月。后來，許多患者還是需要接著注射胰島素。

　　In the newer study， the transplants failed completely within a year in 10 of the 36 patients； but 16 others were off insulin completely， and the remaining 10 needed less insulin than before. By two years， only five were still free of insulin shots. A quarter of the patients had to switch immune-suppressing drugs because of side effects， which sometimes included a drop in kidney function.

　　在新近的研究中，在細胞移植的36例患者中，1年以內(nèi)有10例移植完全失敗；但是另外16例患者完全不在需要胰島素注射，另外10例需要的胰島素的量也比以前減少了。到2年的時候，僅有5例依然不需要注射胰島素。由于副作用的原因，包括出現(xiàn)腎功能下降的情況，四分之一的患者不得不停止使用免疫抑制藥物。

　　For now， the cell transplants are not recommended for most patients.

　　所以現(xiàn)在絕大部分患者都沒有建議采用細胞移植法。

　　"I don‘t think this is ready for prime time，" said Dr. Jonathan S. Bromberg， director of transplantation at Mount Sinai Hospital in Manhattan. He was not involved in the research， but wrote an editorial about it in the same journal.

　　“我認為時機還不成熟，” 曼哈頓西奈山醫(yī)院器官移植主任喬納森·S·布隆伯格博士說。他沒有參與這次研究，但是他在同一期刊上撰寫了關(guān)于研究報告的社評。

　　But he also said the field was advancing so fast that the transplants may actually become a viable option in the not-so-distant future.

　　但是他說，這一領(lǐng)域發(fā)展很快，實際上移植可能在不遠的將來成為可靠的治療方法。

　　"I think we‘ve got every reason to believe there will be significant progress，" Dr. Bromberg said.

　　他表示：“我認為我們有足夠的理由相信這一技術(shù)將會取得重大的進步。”

　　In the meantime， even in their present form， the cell transplants may still help some people - approximately 10 percent of those with Type 1 diabetes， who frequently suffer from severe episodes of low blood sugar， or hypoglycemia， that strike without warning and can cause confusion， fainting or even seizures.

　　同時，即便是在他們現(xiàn)在的情形下，細胞移植對于大約10%的患有I型糖尿病的患者可能依然有用。這些患者經(jīng)常受到嚴重的低血糖癥狀或者低血糖癥的折磨，這些疾病會在沒有任何征兆的情況下發(fā)生，并能誘發(fā)神志不清、昏迷甚至驚厥。

　　This kind of hypoglycemia can be so severe that patients "can‘t function in society，" said Dr. A.M. James Shapiro， who led the study and is director of the islet transplant program at the University of Alberta. His team developed the Edmonton protocol.

　　這種低血糖癥會非常嚴重，可以導(dǎo)致患者“不能正常活動”，領(lǐng)導(dǎo)這項研究的埃爾伯塔胰島移植項目主任A.M. 詹姆斯·夏皮羅博士表示。他領(lǐng)導(dǎo)的團隊開創(chuàng)了埃德蒙頓方案。

　　Patients in the study had the condition， but the transplants diminished their hypoglycemic attacks， even when the cells were only partly effective.

　　研究中的患者都有上述情況，但在細胞移植后，甚至即便在這些細胞只有部分發(fā)揮作用時，他們都免受了低血糖癥的困擾。

　　In the United States， the cell transplants are considered experimental and are available only in studies. They are more widely available in Canada， Dr. Shapiro said.

　　在美國，細胞移植還在試驗階段，只有在研究中可以使用。夏普羅博士介紹說，但在加拿大，細胞移植應(yīng)用更加廣泛。

　　Transplanting the entire pancreas can reverse Type 1 diabetes， but it is a major operation and in this country is usually done only when the diabetes is so severe that the patient needs a kidney transplant as well. About 1，500 pancreas transplants a year are performed in the United States. The transplants tend to work for 5 to 10 years， Dr. Bromberg said. Eventually most patients need insulin again.

　　完全移植整個胰臟可以徹底治療Ⅰ型糖尿病，但是這是一項大手術(shù)，而且在美國只有糖尿病已經(jīng)嚴重到需要腎移植的時候才通常會被采用。布隆伯格博士說，移植往往可以保證5到10年，但大多數(shù)患者最后還是需要注射胰島素。

　　But people with Type 1 do not really need a whole pancreas： they need just the islet cells， which make up only about 3 percent of the organ.

　?、裥吞悄虿』颊卟⒉皇且欢ㄐ枰麄€胰臟的移植，他們只需要相當于整個器官3%的胰島細胞。

　　Researchers have been experimenting with islet transplants since the 1970‘s. But the cells never survived for long in humans - not until the study reported in 2000 by Dr. Shapiro and his colleagues. His team succeeded because they suspected that the immune-suppressing drugs were killing off the islet cells， and they switched to a less toxic regimen. It worked.

　　研究人員從20世紀70年就開始試驗胰島細胞移植。但是直到2000年夏普羅博士和他的同事發(fā)表的研究報告，這些細胞在人體內(nèi)從來就沒有存活過。他的研究小組的成功是由于他們懷疑抑制免疫的藥物同時也殺死了胰島細胞，所以他們成功地使用了一種毒性更小的療法。

　　Even so， too many cells die - half to three quarters， Dr. Shapiro said. If more could survive， patients might be able to go much longer without insulin. Researchers are testing different drug combinations and other refinements to improve their results.

　　夏普羅博士說，即便如此，太多的細胞-大約有一半島3/4，還是死亡了。如果更多的細胞能夠存活，患者不需要使用胰島素的時間就可能會延長。研究人員正在試驗不同的藥物組合和其他的更加精細的方法來提高細胞的成活率。

　　"I would be first to admit that it has a long way to go before it matches whole pancreas transplantation，" Dr. Shapiro said， but he added that he still expected the cell infusions to catch up with whole organ transplants in a few years. The shortage of organ donors will be a limiting factor， however.

　　“首先我得承認，要達到整個胰臟移植的效果還有很長的路要走，”夏普羅博士承認，但是他接著說，他依然期待在幾年的時間里細胞灌輸可以趕上整個胰臟器官移植的效果。然而，缺少胰臟捐獻者將是一個不利因素。

　　Dr. Bromberg said that for most diabetics， new forms of insulin， insulin pumps and glucose monitors were improving control of the disease so much that it would be hard to justify the risks of a transplant and lifelong immune-suppressing drugs.

　　布隆伯格博士說，對于大多數(shù)糖尿病患者，新的合成胰島素、胰島素泵和血糖監(jiān)測儀大量使用，用來改善對疾病的監(jiān)控，但這也使得判斷細胞移植和終生使用免疫抑制藥物的風(fēng)險變得困難。

　　Cell transplants are being studied primarily in people with Type 1 diabetes， which affects about a million people in the United States. It occurs when a person‘s immune system， for unknown reasons， attacks the pancreas cells that make insulin.

　　細胞移植的研究首先是在Ⅰ型糖尿病患者身上進行的，患這種疾病的人在美國大約有100萬人。這一疾病是由于某種不確知的原因致使免疫系統(tǒng)損害產(chǎn)生胰島素的胰島細胞所致。

　　Type 2 diabetes is different， and far more common， affecting about 20 million in the United States. Patients produce insulin， but their bodies cannot use it properly. The disease is genetic， but often develops only when someone who has the genes for it also becomes overweight. Type 2 is increasing in many countries as obesity rises. （Type 1 is not linked to obesity.）

　?、蛐吞悄虿t不同，也更加普遍，在美國大約有2000萬患者?；颊吣軌蚍置谝葝u素，但卻不能正常地使用這些胰島素。這種疾病是遺傳所致，但是通常只在帶有致病遺傳基因同時也體重超標的人才會患這種疾病。Ⅱ型糖尿病隨著肥胖癥的增加在很多國家也有所增加。Ⅰ型糖尿病與肥胖癥無關(guān)。

　　Both forms of the disease can have devastating consequences， including blindness， kidney failure and circulatory problems that can lead to amputations.

　　兩種疾病都可能導(dǎo)致災(zāi)難性的后果，包括失明、腎衰竭和導(dǎo)致的截肢的循環(huán)系統(tǒng)疾病。