糖尿病的免疫抑制治疗

淡化糖尿病的分型为我们提供了一个全新的思维空间。即传统的1型和至少部分2型糖尿病可能都是一种自身免疫性疾病，而目前流行的炎症学说可能是对认可免疫损伤是糖尿病发病理论的一个过渡，我们应该重新审视糖尿病的早期治疗和研究其慢性并发症的发病机理。我们则采用小别量、长时间的治疗理念，早期接受这种免疫治疗的患者出现低血糖的症状，遂减少胰岛素的剂量；再次出现低血糖，我们就继续减少胰岛素的剂量。结果，有部分患者完全摆脱了胰岛素。我们对糖尿病的再认识是建立在对多脏器活检的基础之上。我们的活检结果表明，糖尿病肾病存在着免疫损伤。糖尿病眼底病变是使患者致盲的主要病因，糖尿病患者的眼底病变是一种自身免疫损伤的结果。我们尝试用小剂量的免疫抑制剂环孢菌素A（25mgbid）治疗糖尿病眼底出血，取得了不错的疗效，也证实糖尿病眼底病变是一种血管炎，与自身免疫病变有关。其他的器官还包括垂体、大脑的血管、糖尿病足、冠心病、皮肤的病变和肌肉活检的免疫组化也均有证据表明，免疫损伤是导致多种慢性并发症的罪魁祸首，是一种多器官免疫损伤的结果无论是1型糖尿病，还是2型糖尿病，肌细胞表面或多或少均有免疫复合物沉积。这些免疫复合物的存在势必会影响胰岛素与肌肉细胞表面的胰岛素受体结合，即胰岛素抵抗的存在。为此，我们在临床上广泛采用了免疫抑制治疗的理念治疗糖尿病。应用小剂量胰岛素和小剂量环孢素A治疗早期发现的糖尿病取得了不错的疗效。唯一担心的副作用发生在肝脏，即部分糖尿病患者会出现总胆红素升高，而也有一部分患者总胆红素不升高。

lmmunosappression Therapy for Type 1 Diabetes

It is a completely new idea for us that diabetes mellitus is being declassified, suggested by Edwin Gale who is the chief editor of Diabetologia. It means that there is no clear cut between T1DM and T2DM and the etiology of the both might be the same, due to the autoimmune injuries, T1 is fast while T2 is chronic, and LADA is in between. The inflammatory theory has been recognized by the diabetologists for the time being while the theory of the inflammation due to autoimmune injuries has not been widely appreciated indeed. Furthermore, the way to prevent the chronic complication of diabetes should be reconsidered anyway. Furthermore, we initiated antiautoimmune therapy 7 years ago to the newly diagnosed diabetes with cyclosporine A（low dose,25 rag, bid） plus insulin. As the consequence, hypoglycemia happens, as a result, the dose of insulin will be reduced. For Some patients, insulin therapy was completely stopped within a couplemonths while a part of patients we studied took a year to stop the insulin therapy. Our philosophy is to use a low dose of cyclosporine A for a long period of time. Our new recognition on diabetes is based upon the biopsies of multiple organs from which we found that various immunoglobulin and complements were de posited on them. Based upon these evidence, we tested the new idea on the diabetic retinopathy,nephropathy, neuropathy and even hypertension in the diabetics. The effects seem to be encouraging while the other organs, including the pituitary gland, cerebral artery, coronary artery, diabetic foot and dermopathy were showed a similar effects as well. Because of the autoimmune injuries to muscular cells, the reality of insulin resistance should be reconsidered. In fact, the combination between insulin and its receptor has been blocked by the deposition of immunoglobulin and complements. Among the monority of the patients on cyclosporine therapy the side effects of cyclosporine A we have found is the elevation of total bilirubin in the serum.