The geoepidemiology of type 1 diabetes
The geoepidemiology of type 1 diabetes
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DOI：
10.1016/j.autrev.2009.12.003
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发表时间：
2010-03-01
影响因子：
13.6
通讯作者：
Gershwin, M. E.
中科院分区：
文献类型：
--
作者：
Borchers, Andrea T.;Uibo, Raivo;Gershwin, M. E.
1型糖尿病（T1D）是一种慢性自身免疫性疾病，其特征在于由进行性免疫介导的胰岛细胞破坏引起的绝对胰岛素缺乏。它被认为是由遗传易感个体中尚未确定的环境因素触发的，主要的遗传贡献来自HLA复合体内的基因座，特别是ERA II类。T1D的全球发病率至少相差100倍，芬兰和撒丁岛（意大利）最高，委内瑞拉和中国最低。全世界的发病率以每年约3%的速度增长。虽然遗传因素被认为可以解释T1D发生的一些地理变异性，但它们不能解释其迅速增加的频率。相反，新诊断的高风险基因型儿童的比例下降表明，环境压力现在能够触发T1D基因型，以前不会在儿童时期发展这种疾病。虽然发病率低和高的国家和地区之间的比较表明，较高的社会经济地位和城市化程度是在T1D发病率上升中发挥作用的环境因素之一，但调查结果太不一致，无法得出确切的结论。发病率和死亡率以及死亡原因也显示出相当大的地理差异。虽然血糖控制已被确定为T1 D微血管和大血管并发症的主要预测因素，并显示出相当大的地理差异，但它似乎并不是并发症发生率地区差异的唯一因素。遗传学在肾病、视网膜病变和其他糖尿病并发症易感性中的作用在很大程度上仍有待探索。(C)2009 Elsevier B.V.保留所有权利。
Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by absolute insulin deficiency resulting from the progressive immune-mediated destruction of pancreatic islet 0 cells. It is thought to be triggered by as yet unidentified environmental factors in genetically susceptible individuals, the major genetic contribution coming from loci within the HLA complex, in particular ERA class II. The worldwide incidence of T1D varies by at least 100-fold, being highest in Finland and Sardinia (Italy) and lowest in Venezuela and China. The incidence has been increasing worldwide at an annual rate of approximately 3%. While genetic factors are thought to explain some of the geographic variability in T1D occurrence, they cannot account for its rapidly increasing frequency. Instead, the declining proportion of newly diagnosed children with high-risk genotypes suggests that environmental pressures are now able to trigger T1D in genotypes that previously would not have developed the disease during childhood. Although comparisons between countries and regions with low and high-incidence rates have suggested that higher socioeconomic status and degree of urbanization are among the environmental factors that play a role in the rising incidence of T1D, the findings are too inconsistent to allow firm conclusions. Morbidity and mortality as well as causes of death also show considerable geographic variation. While glycemic control has been identified as a major predictor of the micro- and macrovascular complications of T1D and shows considerable geographical variability, it does not appear to be the only factor involved in the regional differences in complication rates. The role of genetics in susceptibility to nephropathy, retinopathy and other diabetic complications largely remains to be explored. (C) 2009 Elsevier B.V. All rights reserved.