Residual β-Cell Function and HLA-A24 in IDDM: Markers of Glycemic Control and Subsequent Development of Diabetic Retinopathy
Residual β-Cell Function and HLA-A24 in IDDM: Markers of Glycemic Control and Subsequent Development of Diabetic Retinopathy
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IDDM 中的残余 β 细胞功能和 HLA-A24：血糖控制和糖尿病视网膜病变后续发展的标志物
DOI：
10.2337/diab.44.11.1334
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发表时间：
1995
期刊：
影响因子：
7.7
通讯作者：
K. Kosáka
中科院分区：
文献类型：
--
作者：
K. Nakanishi;Tetsuro Kobayashi;H. Inoko;Kimiyoshi Tsuji;T. Murase;K. Kosáka
为确定胰岛素依赖型糖尿病（IDDM）糖尿病视网膜病变的危险因素，我们研究了128例IDDM患者的残余β细胞功能、人类白细胞抗原（HLA）、长期血糖控制和糖尿病视网膜病变之间的关系。通过血清C肽免疫反应性（CPR）对100 g口服葡萄糖负荷（ΔCPR）的反应评估残余β细胞功能。将患者分为三组：ΔCPR <0.033 nmol/1的患者（第1组，n = 50）、ΔCPR为0.033-0.1 nmol/1的患者（第2组，n = 38）和ΔCPR> 0.1 nmol/1的患者（第3组，n = 40）。背景视网膜病变的累积发生率在组1、2和3中依次较高（P = 0.032）。第1组进展为增殖前视网膜病变的时间早于第2组和第3组（P = 0.028）。第1组进一步进展为增殖性视网膜病变的时间往往早于第2组和第3组（P = 0.083）。平均HbA 1c值从第3组的9.01 ± 1.06%（平均值±标准差）上升到第2组的9.75 ± 0.79%和第1组的10.48 ± 1.12%（P <0.0001）。在第1组中，89.6%的患者具有HLA-A24，而在第2组和第3组中分别有50%和43.6%的患者具有该抗原（P <0.0001）。在考克斯的比例风险模型中，调整其他潜在风险因素后，血清CPR反应和平均HbA 1c值均被确定为糖尿病视网膜病变发展的独立风险因素。这些结果表明，与HLA-A24相关的β细胞功能的完全丧失通过代谢控制预测糖尿病视网膜病变的早期发生。
To identify risk factors for diabetic retinopathy in insulin-dependent diabetes mellitus (IDDM), we studied the relationships among residual β-cell function, human leukocyte antigen (HLA), long-term glycemic control, and development of diabetic retinopathy in 128 IDDM patients. Residual β-cell function was assessed by serum C-peptide immunoreactivity (CPR) response to a 100-g oral glucose load (ΔCPR). The patients were stratified into three groups: those with ΔCPR of <0.033 nmol/1 (group 1, n = 50), those with ΔCPR of 0.033–0.1 nmol/1 (group 2, n = 38), and those with ΔCPR of > 0.1 nmol/1 (group 3, n = 40). The cumulative incidence rate of background retinopathy was higher in the order of groups 1, 2, and 3 (P = 0.032). Group 1 progressed to preproliferative retinopathy at an earlier stage than did groups 2 and 3 combined (P = 0.028). Further progression to proliferative retinopathy tended to be earlier in group 1 than in groups 2 and 3 combined (P = 0.083). The mean HbA1c value rose from 9.01 ± 1.06% (mean ± SD) in group 3 to 9.75 ± 0.79% in group 2 to 10.48 ± 1.12% in group 1 (P <0.0001). In group 1, 89.6% of the patients had HLA-A24, whereas 50 and 43.6% of the patients had this antigen in groups 2 and 3 respectively (P <0.0001). In Cox's proportional hazards model, both serum CPR response and mean HbA1c value were identified as independent risk factors for development of diabetic retinopathy after adjusting for other potential risk factors. These results indicate that complete loss of β-cell function, which is associated with HLA-A24, predicts earlier occurrence of diabetic retinopathy through metabolic control.
遗传因素在糖尿病微血管病变的发病机制中起作用吗？
影响因子：
8.2
作者：
Barbosa,J;Saner,B
通讯作者：
Saner,B