MATURITY-ONSET DIABETES OF YOUTH IN BLACK-AMERICANS
MATURITY-ONSET DIABETES OF YOUTH IN BLACK-AMERICANS
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DOI：
10.1056/nejm198702053160601
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发表时间：
1987-02-05
影响因子：
158.5
通讯作者：
SPILLAR, RP
中科院分区：
文献类型：
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作者：
WINTER, WE;MACLAREN, NK;SPILLAR, RP
129例青年发病的黑人糖尿病患者中有12例被确定为具有不寻常的临床病程，在就诊时具有明显的胰岛素依赖，随后数月至数年后没有依赖。在12个先证者家族中的9个家族中，至少有两代人发现了这种非典型糖尿病。14名糖尿病患者亲属和12名先证者接受了研究。胰岛细胞自身抗体未发现在任何患者，甲状腺微粒体自身抗体被发现在只有一个。胰岛素依赖型糖尿病相关抗原HLA-DR 3和DR 4的频率在先证者中没有增加，糖尿病与HLA单倍型在提供信息的家族中没有共分离。通过对液体混合餐（Sustacal）的C肽反应测量的胰岛素分泌介于非糖尿病对照组和经典胰岛素依赖型糖尿病患者的分泌之间。外周血单核细胞表达的胰岛素受体数量增加，以及减少空位点的亲和力。非典型形式的糖尿病在美国黑人可以区别于经典定义的胰岛素依赖型糖尿病，并可能是最好的分类为一种形式的成熟发病的糖尿病的青年。
Twelve of 129 black patients with youth-onset diabetes were identified as having an unsual clinical course, with apparent insulin dependence at the time of presentation followed by absence of dependence months to years later. This atypical form of diabetes was found in at least two generations in 9 of the 12 families of the propositi. Fourteen of the diabetic relatives, as well as the 12 propositi, were studied. Islet-cell autoantibodies were not found in any of the patients, and thyroid microsomal autoantibodies were found in only one. The frequencies of the insulin-dependent-diabetes-associated antigens HLA-DR3 and DR4 were not increased among the propositi, and diabetes did not cosegregate with HLA haplotypes in the informative families. Insulin secretion, as measured by C-peptide responses to a liquid mixed meal (Sustacal), was intermediate between secretion in nondiabetic controls and that in patients with classic insulin-dependent diabetes. Peripheral-blood monocytes expressed increased numbers of insulin receptors as well as decreased empty-site affinities. The atypical form of diabetes in black Americans can be distinguished from classically defined insulin-dependent diabetes and may be best classified as a form of maturity-onset diabetes of youth.