预防胰岛素抗拒的方法

 

细胞移植法治疗糖尿病遭遇尴尬

 

　　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《新英格兰医学杂志》上的报告显示，细胞移植的确免除了患者注射胰岛素之苦，但是作用却只是暂时的：86%的患者在2年以内再次需要新的胰岛素。

 

　　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.

 

　　患有严重的I型糖尿病，也称为青少年糖尿病的患者体内缺少胰岛素，为了控制血糖必须每天多次注射胰岛素。他们被移植了死亡的器官捐献者的胰脏细胞。

 

　　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.

 

　　移植手术不需要动大手术，只需要在患者腹部的血管中插入一个导管把细胞倒入患者的肝脏，细胞就依附在肝脏细小的血管上。因为细胞来自于别人体内，接受移植的患者必须终生服用免疫抑制药物，预防产生排异现象。

 

　　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.

 

　　这项研究是在来自于美国、加拿大和欧洲9个中心的36名患者身上进行的。研究受到2000年发布的一项小规模的试验结果的启发，那一试验提出了让人兴奋的移植技术，即在埃尔伯塔大学发展起来的埃德蒙顿方案。在起初的试验中，没有一个患者需要注射胰岛素。但是到试验报告发布的时候，所有的病人跟踪观察还不到14个月。后来，许多患者还是需要接着注射胰岛素。

 

　　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，在细胞移植的36例患者中，1年以内有10例移植完全失败；但是另外16例患者完全不在需要胰岛素注射，另外10例需要的胰岛素的量也比以前减少了。到2年的时候，仅有5例依然不需要注射胰岛素。由于副作用的原因，包括出现肾功能下降的情况，四分之一的患者不得不停止使用免疫抑制药物。

 

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

 

　　所以现在绝大部分患者都没有建议采用细胞移植法。

 

　　"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.

 

　　"我认为时机还不成熟，" 曼哈顿西奈山医院器官移植主任乔纳森·S·布隆伯格博士说。他没有参与这次研究，但是他在同一期刊上撰写了关于研究报告的社评。

 

　　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.

 

　　但是他说，这一领域发展很快，实际上移植可能在不远的将来成为可靠的治疗方法。

 

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

 

　　他表示："我认为我们有足够的理由相信这一技术将会取得重大的进步。"

 

　　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.

 

　　同时，即便是在他们现在的情形下，细胞移植对于大约10%的患有I型糖尿病的患者可能依然有用。这些患者经常受到严重的低血糖症状或者低血糖症的折磨，这些疾病会在没有任何征兆的情况下发生，并能诱发神志不清、昏迷甚至惊厥。

 

　　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.

 

　　这种低血糖症会非常严重，可以导致患者"不能正常活动"，领导这项研究的埃尔伯塔胰岛移植项目主任A.M. 詹姆斯·夏皮罗博士表示。他领导的团队开创了埃德蒙顿方案。

 

　　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况，但在细胞移植后，甚至即便在这些细胞只有部分发挥作用时，他们都免受了低血糖症的困扰。

 

　　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.

 

　　在美国，细胞移植还在试验阶段，只有在研究中可以使用。夏普罗博士介绍说，但在加拿大，细胞移植应用更加广泛。

 

　　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.

 

　　完全移植整个胰脏可以彻底治疗I型糖尿病，但是这是一项大手术，而且在美国只有糖尿病已经严重到需要肾移植的时候才通常会被采用。布隆伯格博士说，移植往往可以保证5到10年，但大多数患者最后还是需要注射胰岛素。

 

　　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.

 

　　I型糖尿病患者并不是一定需要整个胰脏的移植，他们只需要相当于整个器官3%的胰岛细胞。

 

　　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.

 

　　研究人员从20世纪70年就开始试验胰岛细胞移植。但是直到2000年夏普罗博士和他的同事发表的研究报告，这些细胞在人体内从来就没有存活过。他的研究小组的成功是由于他们怀疑抑制免疫的药物同时也杀死了胰岛细胞，所以他们成功地使用了一种毒性更小的疗法。

 

　　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.

 

　　夏普罗博士说，即便如此，太多的细胞-大约有一半岛3/4，还是死亡了。如果更多的细胞能够存活，患者不需要使用胰岛素的时间就可能会延长。研究人员正在试验不同的药物组合和其他的更加精细的方法来提高细胞的成活率。

 

　　Tips for Preventing Insulin Resistance

 

预防胰岛素抗拒的技巧

 

　　-- A healthy diet and lifestyle can go a long way in preventing insulin resistance, diabetes and heart disease in overweight people. Some tips:

 

　　健康的饮食习惯和生活习惯对于预防超重人群的胰岛素抵抗、糖尿病和心脏病十分重要。这里提供一些窍门：

 

　　_Get at least 30 minutes of moderate exercise, enough to raise your heart rate but not leave you short of breath, five times a week. Exercising muscles makes them more receptive to insulin and helps them burn more glucose.

 

　　每周五次运动量适中的、每次至少30分钟的锻炼。这些锻炼只要能够提高心率，不至于造成气短就够了。 锻炼肌肉可以使胰岛素更容易吸收，同时还可以消耗更多的葡萄糖。

 

　　_Have several small meals each day, rather than a few large ones, to avoid ups and downs in blood sugar.

 

　　每天少吃多餐，而不是一天就几次的暴饮暴食，一次避免血糖起伏太大。

 

　　_Eat more fruits, vegetables and whole grains, particularly oats, beans and legumes; the fiber slows digestion, limiting spikes and drops in blood insulin and sugar levels.

 

　　多吃蔬菜、水果和全麦制品，尤其是燕麦、大豆和豆荚；这些食物中的植物纤维可以延缓消化，减少血液中胰岛素和血糖水平的巨大起伏。

 

　　_Eat fewer processed meats and other animal products, butter and other saturated fats, and trans fats, which are in many processed foods; they can limit the ability of insulin to regulate blood sugar. Use healthy cooking oils, such as canola, sunflower or olive oil.

 

　　少吃加工好的肉类或其他动物制品、黄油以及很多加工过的食品中含有的其他的饱和脂肪酸和转化脂肪。这些物质能够限制胰岛素平衡血糖的能力。使用健康的烹饪用油，比如芥花籽油，葵花子油或橄榄油。

 

　　_Limit consumption of sugary drinks, desserts and other sweets. Keep healthy snacks handy.

 

　　减少含糖饮料、甜点和其他糖类物质的摄入量。身边放上健康的零食。

 

　　_Avoid high-sodium prepared foods, which can push up blood pressure.

 

　　避免食用高盐的食物，因为这些食物可能提高血压。

 

　　_Drink milk or eat dairy products; the proteins and enzymes in them slow conversion of glucose to blood sugar, which can reduce risk of insulin resistance developing.

 

　　喝牛奶或者食用奶制品。它们含有的蛋白质和酶可以延缓葡萄糖转化为血糖，这样就可以降低胰岛素抵抗发病的风险。

 

　　_Get six to eight hours sleep a night, as inadequate rest can disrupt blood sugar levels and raise insulin resistance.

 

　　每天晚上保持6-8小时的睡眠时间。休息不足会干扰血糖水平，提高胰岛素抵抗。

 

　　_Try meditation, deep breathing or other relaxation methods. One study showed they can reduce high blood sugar levels.

 

　　尝试静坐、吐纳和其他放松的方法。一项研究表明，这些活动能够降低血糖。