A PROSPECTIVE-STUDY OF THE DEVELOPMENT OF DIABETES IN RELATIVES OF PATIENTS WITH INSULIN-DEPENDENT DIABETES
A PROSPECTIVE-STUDY OF THE DEVELOPMENT OF DIABETES IN RELATIVES OF PATIENTS WITH INSULIN-DEPENDENT DIABETES
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DOI：
10.1056/nejm199010253231704
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发表时间：
1990-10-25
影响因子：
158.5
通讯作者：
ROTTER, JI
中科院分区：
文献类型：
--
作者：
RILEY, WJ;MACLAREN, NK;ROTTER, JI
背景：细胞质胰岛细胞自身抗体的存在已被认为是胰岛素依赖型糖尿病（IDDM）患者亲属发生糖尿病的危险因素，但该风险的严重程度以及其他因素（如年龄、性别和种族）的影响尚不清楚。方法：从 1979 年到 1989 年，我们研究了 1590 名 IDDM 先证者的 4015 名最初非糖尿病亲属，根据自身抗体的存在和滴度以及其他因素确定 IDDM 的风险。结果：在 4015 名非糖尿病亲属中，125 名（3.1%）的初始血清样本中含有胰岛细胞抗体，40 名患有 IDDM。胰岛细胞抗体在 20 岁以下的亲属中最常见（4.3%）（P = 0.001），在来自有超过一名受影响成员的家庭（多重谱系）的亲属中（4.8%）（P = 0.003）。亲属患糖尿病的独立危险因素包括初始研究时年龄小于 10 岁 (P = 0.001)、多重谱系成员身份 (P = 0.02) 以及初始血清样本中胰岛细胞抗体检测呈阳性 (P = 0.0001)。 27 名患有糖尿病的亲属 (67.5%) 在诊断 IDDM 之前胰岛细胞抗体检测呈阳性，抗体阳性亲属患 IDDM 的相对风险为 68（95% 置信区间，34 至 134）。胰岛细胞抗体滴度达到 20 个青少年糖尿病基金会单位或更高与糖尿病风险增加相关。结论：IDDM 先证者的非糖尿病亲属，年龄在 20 岁以内，是多重谱系的成员，并且胰岛细胞抗体滴度增加，最有可能感染 IDDM。
Background: The presence of cytoplasmic islet-cell autoantibodies has been recognized as a risk factor for the development of diabetes mellitus in relatives of patients with insulin-dependent diabetes mellitus (IDDM), but the magnitude of the risk is unknown, as is the influence of other factors, such as age, sex, and race. Methods: From 1979 through 1989, we studied 4015 initially nondiabetic relatives of 1590 probands with IDDM to determine the risk of IDDM according to the presence and titer of autoantibodies, as well as other factors. Results: Of the 4015 nondiabetic relatives, 125 (3.1 percent) had islet-cell antibodies in their initial serum samples, and 40 contracted IDDM. Islet-cell antibodies were most frequent (4.3 percent) in relatives who were under 20 years of age (P = 0.001) and in those (4.8 percent) from families with more than one affected member (a multiplex pedigree) (P = 0.003). Independent risk factors for the development of diabetes in the relatives included age of less than 10 years at the time of the initial study (P = 0.001), membership in a multiplex pedigree (P = 0.02), and a positive test for islet-cell antibodies in the initial serum sample (P = 0.0001). Twenty-seven of the relatives in whom diabetes developed (67.5 percent) had positive tests for islet-cell antibodies before the diagnosis of IDDM giving a relative risk of IDDM of 68 (95 percent confidence interval, 34 to 134) for antibody-positive relatives. Islet-cell-antibody titers of 20 Juvenile Diabetes Foundation units or higher were associated with an increasing risk of diabetes. Conclusions: Nondiabetic relatives of probands with IDDM who are in the first two decades of life, are members of multiplex pedigrees, and have increased titers of islet-cell antibodies are the most likely to contract IDDM themselves.