The diabetes pandemic and associated infections: suggestions for clinical microbiology
The diabetes pandemic and associated infections: suggestions for clinical microbiology
复制标题
DOI：
10.1097/mrm.0000000000000155
复制
发表时间：
2019-01-01
影响因子：
--
通讯作者：
Ferrannini, Ele
中科院分区：
文献类型：
--
作者：
Toniolo, Antonio;Cassani, Gianluca;Ferrannini, Ele
全球有 4.25 亿糖尿病患者。到2045年，这个数字将增长到6亿以上。糖尿病属于非传染性疾病。有证据表明微生物在糖尿病中发挥着关键作用，它既是与糖尿病状态相关的传染源，又是糖尿病的可能致病因素。本综述考虑了不同形式的糖尿病、易患 1 型和 2 型糖尿病的遗传决定因素（尤其是那些可能具有免疫影响的因素）、糖尿病中已记录的免疫功能障碍。回顾了糖尿病患者与非糖尿病患者中更常见的常见感染。介绍了被怀疑在糖尿病中起病因/触发作用的感染因子，重点是肠道病毒、卫生假说和环境。在可能与糖尿病相关的生物制剂中，讨论了肠道微生物组、丙型肝炎病毒和朊病毒样蛋白聚集体。最后，考虑在糖尿病患者管理中推荐的预防性疫苗，包括正在针对 1 型糖尿病进行测试的卡美特-格林芽孢杆菌疫苗。有证据支持这样的观点，即免疫防御的减弱（先天性和继发性代谢紊乱以及微血管病和神经病）使糖尿病患者更容易受到某些感染。因此，建议对糖尿病患者进行仔细的微生物监测。由于遗传倾向无法改变，因此研究需要确定可能在糖尿病中起病因作用的生物制剂，并设想限制糖尿病流行的治疗和预防方法。版权所有 (C) 2018 作者。由 Wolters Kluwer Health, Inc. 出版
There are 425 million people with diabetes mellitus in the world. By 2045, this figure will grow to over 600 million. Diabetes mellitus is classified among noncommunicable diseases. Evidence points to a key role of microbes in diabetes mellitus, both as infectious agents associated with the diabetic status and as possible causative factors of diabetes mellitus. This review takes into account the different forms of diabetes mellitus, the genetic determinants that predispose to type 1 and type 2 diabetes mellitus (especially those with possible immunologic impact), the immune dysfunctions that have been documented in diabetes mellitus. Common infections occurring more frequently in diabetic vs. nondiabetic individuals are reviewed. Infectious agents that are suspected of playing an etiologic/triggering role in diabetes mellitus are presented, with emphasis on enteroviruses, the hygiene hypothesis, and the environment. Among biological agents possibly linked to diabetes mellitus, the gut microbiome, hepatitis C virus, and prion-like protein aggregates are discussed. Finally, preventive vaccines recommended in the management of diabetic patients are considered, including the bacillus calmette-Guerin vaccine that is being tested for type 1 diabetes mellitus. Evidence supports the notion that attenuation of immune defenses (both congenital and secondary to metabolic disturbances as well as to microangiopathy and neuropathy) makes diabetic people more prone to certain infections. Attentive microbiologic monitoring of diabetic patients is thus recommendable. As genetic predisposition cannot be changed, research needs to identify the biological agents that may have an etiologic role in diabetes mellitus, and to envisage curative and preventive ways to limit the diabetes pandemic. Copyright (C) 2018 The Author(s). Published by Wolters Kluwer Health, Inc.