Pancreas Volume Declines During the First Year After Diagnosis of Type 1 Diabetes and Exhibits Altered Diffusion at Disease Onset
Pancreas Volume Declines During the First Year After Diagnosis of Type 1 Diabetes and Exhibits Altered Diffusion at Disease Onset
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DOI：
10.2337/dc18-1507
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发表时间：
2019-02-01
期刊：
影响因子：
16.2
通讯作者：
Moore, Daniel J.
中科院分区：
文献类型：
--
作者：
Virostko, John;Williams, Jon;Moore, Daniel J.
研究目的本研究调查了儿童和青少年1型糖尿病（T1 D）患者和非糖尿病患者胰腺体积和微观结构的时间动态变化，包括表达与T1 D早期相关的自身抗体的亚群。研究设计和方法（n = 51;中位年龄13岁）在诊断后100天内（平均67天），6个月和1年诊断后。纵向MRI测量也进行了类似的年龄控制参与者（n = 57）和自身抗体阳性的个人没有糖尿病（n = 20）。MRI方案包括确定胰腺体积的解剖成像和询问组织微观结构和组成的定量MRI方案。在糖尿病发作的100天内，T1 D个体的胰腺（中位体积28.6 mL）小于对照参与者（中位体积48.4 mL; P < 0.001），包括按个体体重标准化时（P < 0.001）。对照组参与者胰腺体积的纵向测量值在一年中增加，与青少年生长一致，但胰腺体积在T1 D诊断后的第一年内下降（P < 0.001）。在多个自身抗体阳性个体中，胰腺体积显著大于T1 D队列（P = 0.017），但小于对照队列（P = 0.04）。弥散加权MRI显示，近期发作的T1 D患者的表观弥散系数较高，（P = 0.012），提示细胞结构完整性丧失，胰腺分布不均匀。和3的T1 D，并在糖尿病发病后的第一年减少，胰腺体积的这种损失伴随着显微结构的变化。
OBJECTIVEThis study investigated the temporal dynamics of pancreas volume and microstructure in children and adolescents with recent-onset type 1 diabetes (T1D) and individuals without diabetes, including a subset expressing autoantibodies associated with the early stages of T1D.RESEARCH DESIGN AND METHODSMRI was performed in individuals with recent-onset stage 3 T1D (n = 51; median age 13 years) within 100 days after diagnosis (mean 67 days), 6 months, and 1 year postdiagnosis. Longitudinal MRI measurements were also made in similarly aged control participants (n = 57) and in autoantibody-positive individuals without diabetes (n = 20). The MRI protocol consisted of anatomical imaging to determine pancreas volume and quantitative MRI protocols interrogating tissue microstructure and composition.RESULTSWithin 100 days of diabetes onset, individuals with T1D had a smaller pancreas (median volume 28.6 mL) than control participants (median volume 48.4 mL; P < 0.001), including when normalized by individual weight (P < 0.001). Longitudinal measurements of pancreas volume increased in control participants over the year, consistent with adolescent growth, but pancreas volume declined over the first year after T1D diagnosis (P < 0.001). In multiple autoantibody-positive individuals, the pancreas volume was significantly larger than that of the T1D cohort (P = 0.017) but smaller than that of the control cohort (P = 0.04). Diffusion-weighted MRI showed that individuals with recent-onset T1D had a higher apparent diffusion coefficient (P = 0.012), suggesting a loss of cellular structural integrity, with heterogeneous pancreatic distribution.CONCLUSIONSThese results indicate that pancreas volume is decreased in stages 1, 2, and 3 of T1D and decreases during the first year after diabetes onset and that this loss of pancreatic volume is accompanied by microstructural changes.