Autoantibody-negative insulin-dependent diabetes mellitus after SARS-CoV-2 infection: a case report
Autoantibody-negative insulin-dependent diabetes mellitus after SARS-CoV-2 infection: a case report
复制标题
DOI：
10.1038/s42255-020-00281-8
复制
发表时间：
2020-10-01
影响因子：
20.8
通讯作者：
Laudes, Matthias
中科院分区：
文献类型：
--
作者：
Hollstein, Tim;Schulte, Dominik M.;Laudes, Matthias
在这里，我们报告的情况下，胰岛素依赖型糖尿病的表现发生后，SARS冠状病毒-2感染的年轻人在1型糖尿病的典型自身抗体的情况下。具体来说，一名19岁的白色男性在急诊科就诊，表现为糖尿病酮症酸中毒，C肽水平为0.62 μ g l（-1），血糖浓度为30.6 mmol l（-1）（552 mg dl（-1）），血红蛋白A1 c为16.8%。根据酶联免疫吸附试验确定的SARS-CoV-2蛋白抗体检测阳性，患者的病史显示可能在入院前5-7周感染COVID-19。有趣的是，该患者携带人类白细胞抗原基因型（HLA DR 1-DR 3-DQ 2），被认为仅略微增加了发生自身免疫性1型糖尿病的风险。然而，如前所述，未观察到针对胰岛细胞、谷氨酸脱羧酶、酪氨酸磷酸酶、胰岛素和锌转运蛋白8的血清自身抗体。虽然我们的报告不能完全确定COVID-19与该患者糖尿病发展之间的因果关系，但考虑到SARS-CoV-2进入受体，包括血管紧张素转换酶2，在胰腺β细胞上表达，并且考虑到该病例的情况，我们认为SARS-CoV-2感染或COVID-19可能对胰腺功能产生负面影响，可能是通过病毒对β细胞的直接细胞溶解作用。
Here we report a case where the manifestations of insulin-dependent diabetes occurred following SARS-CoV-2 infection in a young individual in the absence of autoantibodies typical for type 1 diabetes mellitus. Specifically, a 19-year-old white male presented at our emergency department with diabetic ketoacidosis, C-peptide level of 0.62 mu g l(-1), blood glucose concentration of 30.6 mmol l(-1) (552 mg dl(-1)) and haemoglobin A1c of 16.8%. The patient's case history revealed probable COVID-19 infection 5-7 weeks before admission, based on a positive test for antibodies against SARS-CoV-2 proteins as determined by enzyme-linked immunosorbent assay. Interestingly, the patient carried a human leukocyte antigen genotype (HLA DR1-DR3-DQ2) considered to provide only a slightly elevated risk of developing autoimmune type 1 diabetes mellitus. However, as noted, no serum autoantibodies were observed against islet cells, glutamic acid decarboxylase, tyrosine phosphatase, insulin and zinc-transporter 8. Although our report cannot fully establish causality between COVID-19 and the development of diabetes in this patient, considering that SARS-CoV-2 entry receptors, including angiotensin-converting enzyme 2, are expressed on pancreatic beta-cells and, given the circumstances of this case, we suggest that SARS-CoV-2 infection, or COVID-19, might negatively affect pancreatic function, perhaps through direct cytolytic effects of the virus on beta-cells.