Substance Use Affects Type 1 Diabetes Pancreas Pathology: Implications for Future Studies.
Substance Use Affects Type 1 Diabetes Pancreas Pathology: Implications for Future Studies.
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DOI：
10.3389/fendo.2021.778912
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发表时间：
2021
影响因子：
5.2
通讯作者：
Jacobsen LM
中科院分区：
文献类型：
--
作者：
Bruggeman BS;Campbell-Thompson M;Filipp SL;Gurka MJ;Atkinson MA;Schatz DA;Jacobsen LM
从器官捐献者获得人类胰腺样本极大地促进了我们对1型糖尿病发病机制的理解;然而，以前的研究表明，捐献者有很高的物质使用率，并且其对这种疾病的胰腺组织病理学的影响没有得到很好的描述。131例1型糖尿病患者和111例12-89岁对照器官供体胰腺对糖尿病胰腺器官捐献者网络（nPOD）中的30名患者（平均年龄29.8 ± 15.5岁）进行胰岛素阳性、胰岛炎、淀粉样蛋白染色、急性和慢性胰腺炎以及慢性外分泌变化检查（腺泡萎缩、纤维化、脂肪浸润或导管周围纤维化）;根据药物使用史比较结果。次要分析比较了1型糖尿病与对照器官供体的胰腺外分泌组织病理学结果，无论物质使用史如何。我们观察到1型糖尿病和对照器官捐献者的物质使用率较高，但一致（分别为66.4%和64%）。在1型糖尿病供体（但非对照组）中，胰岛淀粉样蛋白（OR 9.96 [1.22，81.29]）和急性胰腺炎（OR 3.2 [1.06，9.63]）在酒精使用者中更常见，而慢性外分泌变化（OR 8.86 [1.13，69.31]）在可卡因使用者中更常见。物质使用对1型糖尿病供体胰腺的影响大于对照组。总体而言，尽管物质使用率相似，但1型糖尿病供体中急性胰腺炎（15.3% vs 4.5%，p=0.0061）、慢性胰腺炎（29.8% vs 9.9%，p=0.0001）和慢性外分泌改变（73.3% vs 36.9%，p<0.0001）比对照组更常见。1型糖尿病器官捐献者使用酒精和/或可卡因会增加胰腺外分泌病理和胰岛淀粉样蛋白沉积，但不影响胰岛炎或胰岛素阳性。1型糖尿病供体的外分泌病理学是常见的，需要进一步研究这些变化的病理生理学。
Access to human pancreas samples from organ donors has greatly advanced our understanding of type 1 diabetes pathogenesis; however, previous studies have shown that donors have a high rate of substance use, and its impact on pancreatic histopathology in this disease is not well described. One-hundred-thirty-one type 1 diabetes and 111 control organ donor pancreata from persons 12-89 years of age (mean 29.8 ± 15.5 years) within the Network for Pancreatic Organ donors with Diabetes (nPOD) were examined for insulin positivity, insulitis, amyloid staining, acute and chronic pancreatitis, and chronic exocrine changes (acinar atrophy, fibrosis, fatty infiltration, or periductal fibrosis); findings were compared by history of substance use. A secondary analysis compared exocrine pancreatic histopathologic findings in type 1 diabetes versus control organ donors regardless of substance use history. We observed a high but congruent rate of substance use in type 1 diabetes and control organ donors (66.4% and 64% respectively). Among donors with type 1 diabetes (but not controls), islet amyloid (OR 9.96 [1.22, 81.29]) and acute pancreatitis (OR 3.2 [1.06, 9.63]) were more common in alcohol users while chronic exocrine changes (OR 8.86 [1.13, 69.31]) were more common in cocaine users. Substance use impacted the pancreata of donors with type 1 diabetes more than controls. Overall, despite similar rates of substance use, acute pancreatitis (15.3% versus 4.5%, p=0.0061), chronic pancreatitis (29.8% versus 9.9%, p=0.0001), and chronic exocrine changes (73.3% versus 36.9%, p<0.0001) were more common in type 1 diabetes donors than controls. Alcohol and/or cocaine use in type 1 diabetes organ donors increases exocrine pancreas pathology and islet amyloid deposition but does not affect insulitis or insulin positivity. Exocrine pathology in type 1 diabetes donors is common, and further study of the pathophysiology of these changes is needed.
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