The heterogeneity of islet autoantibodies and the progression of islet failure in type 1 diabetic patients
The heterogeneity of islet autoantibodies and the progression of islet failure in type 1 diabetic patients
复制标题
1型糖尿病患者胰岛自身抗体的异质性和胰岛衰竭的进展
DOI：
10.1007/s11427-016-5052-3
复制
发表时间：
2016-09-01
影响因子：
9.1
通讯作者：
Yang, Tao
中科院分区：
文献类型：
--
作者：
Liu, Jin;Bian, Lingling;Yang, Tao
1 型糖尿病在许多方面都有异质性。患有 1 型糖尿病的患者表现出多种水平的胰岛功能以及不同数量和类型的胰岛特异性自身抗体。本研究旨在调查 1 型糖尿病的胰岛自身抗体和临床表型的患病率和异质性；并探讨了中国1型糖尿病患者胰岛衰竭的过程及其危险因素。共有 1,291 名 1 型糖尿病患者参与了这项研究。收集了人口统计信息。实验室检查包括混合膳食耐受试验、人类白细胞抗原等位基因、糖化血红蛋白、血脂、甲状腺功能和胰岛自身抗体。华东地区初诊T1DM患者（病程短于半年）胰岛特异性自身抗体出现率为73%。根据二元逻辑回归，自身抗体阳性、持续时间较长和体重指数较低是胰岛衰竭的危险因素。随着疾病的发展，针对谷氨酸脱羧酶的自身抗体以及针对锌转运蛋白 8 和胰岛抗原 2 的另外两种自身抗体均下降。自身抗体的下降与积极的 β 细胞破坏呈正相关。自身抗体可以帮助识别经典 T1DM 与其他亚型，并预测胰岛衰竭的进展。由于不同表型的自身抗体和临床表现存在明显的异质性，因此在识别1型糖尿病时应考虑更多因素。
Type 1 diabetes mellitus is heterogeneous in many facets. The patients suffered from type 1 diabetes present several levels of islet function as well as variable number and type of islet-specific autoantibodies. This study was to investigate prevalence and heterogeneity of the islet autoantibodies and clinical phenotypes of type 1 diabetes mellitus; and also discussed the process of islet failure and its risk factors in Chinese type 1 diabetic patients. A total of 1,291 type 1 diabetic patients were enrolled in this study. Demographic information was collected. Laboratory tests including mixed-meal tolerance test, human leukocyte antigen alleles, hemoglobinA1c, lipids, thyroid function and islet autoantibodies were conducted. The frequency of islet-specific autoantibody in newly diagnosed T1DM patients (duration shorter than half year) was 73% in East China. According to binary logistic regressions, autoantibody positivity, longer duration and lower Body Mass Index were the risk factors of islet failure. As the disease developed, autoantibodies against glutamic acid decarboxylase declined as well as the other two autoantibodies against zinc transporter 8 and islet antigen 2. The decrease of autoantibodies was positively correlated with aggressive beta cell destruction. Autoantibodies can facilitate the identification of classic T1DM from other subtypes and predict the progression of islet failure. As there were obvious heterogeneity in autoantibodies and clinical manifestation in different phenotypes of the disease, we should take more factors into consideration when identifying type 1 diabetes mellitus.