Permanent diabetes mellitus in the first year of life
Permanent diabetes mellitus in the first year of life
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DOI：
10.1007/s00125-002-0837-2
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发表时间：
2002-06-01
期刊：
影响因子：
8.2
通讯作者：
Prisco, F
中科院分区：
文献类型：
--
作者：
Iafusco, D;Stazi, MA;Prisco, F
目的/假设。在生命早期诊断的永久性糖尿病的发病机制是异质性的，并且在大多数情况下，尚不清楚。我们的目的是确定标记物区分非自身免疫性和自身免疫性糖尿病。对62例出生后12个月内接受胰岛素治疗的II型糖尿病患者（男性）的临床、遗传和流行病学特征进行了研究。糖尿病发病年龄的流行曲线显示，在180天的截止日期，患者分为两个亚组。在糖尿病发病180天之前的组（“早发性”永久性糖尿病）中，HLA易感性异二聚体分析（可获得21个个体）显示76%具有I型（胰岛素依赖型）糖尿病的“保护性”HLA基因型，而晚发性组为11.9%（5/42）。因此，与180天后发病的儿童（20例受试者中有13例）相比，“早发性”儿童（26例受试者中有4例）出现自身免疫标志物的可能性较小（15.4% vs. 65.0%，p180天）。出生体重偏小是胎儿胰岛素分泌减少的一个可能迹象，在“早发”组中更常见（OR=9.9，95%-CI 2.6-38.6）。这些结果，在最大的人群为基础的队列糖尿病婴儿迄今报道，表明“早发性”永久性糖尿病病例不同于晚发性病例，他们中的大多数没有自身免疫发病机制。
Aims/hypothesis. The pathogenesis of permanent diabetes mellitus diagnosed early in life is heterogeneous and, in most cases, not known. We aimed at identifying markers differentiating between non-autoimmune and autoimmune diabetes.Methods. The clinical, genetic and epidemiological features of I I I diabetic patients (62 males) who received insulin within 12 months of life were studied.Results. The epidemic curve by age of diabetes onset revealed two subsets of patients at a cutoff of 180 days. In the group with diabetes onset before 180 days ("early onset" permanent diabetes) the analysis of HLA susceptibility heterodimers (available for 21 individuals) showed that 76% had a "protective" HLA genotype for Type I (insulin-dependent) diabetes mellitus as compared to 11.9% (5/42) of the later onset group. Accordingly, "early onset" children were less likely to have autoimmunity markers (4 out of 26 tested) than children with onset after 180 days (13 out 20 tested) (15.4% vs. 65.0%, p180 days). Small-for-date birthweight, a possible sign of reduced foetal insulin secretion, was more common in the "early onset" group (OR=9.9, 95%-CI 2.6-38.6).Conclusion/interpretation. These results, obtained in the largest population-based cohort of diabetic infants hitherto reported, suggest that "early onset" permanent diabetes cases differ from later onset cases and that most of them do not have an autoimmune pathogenesis.