Maugendre D, Sonnet E, Derrien C, Le Golff M C, Grais M C, Allannic H, Delamaire M
Clinique de Diabétologie-Endocrinologie, CHU, Hôpital Sud, Rennes, France.
Diabetes Metab. 1999 Mar;25(1):28-33.
The prevalence and levels of islet-cell antibodies (ICA) decrease in the years following diabetes onset but may persist, particularly in patients with concomitant autoimmune disease. The aim of this cross-sectional study was to investigate the frequencies, associations and levels of the major anti-beta-cell antibodies in long-standing diabetic patients (median duration: 14 years; range 5-47 years) with and without autoimmune thyroid disease (ATD) in order to consider the specific antipancreatic immunologic features associated with endocrine autoimmunity. Both ICA and glutamic acid decarboxylase (GAD) antibody (GAD-A) frequencies were increased in diabetic patients with ATD (38 vs 23%, p = 0.03 and 70 vs 21%, p < 10(-4) respectively). Although IA2-A frequency tended to be higher in diabetic patients with ATD, no significant difference was seen (37 vs 26%, p = 0.14). GAD median level was significantly higher in the diabetic group with ATD (15 vs 5 units, p < 10(-4)). IA2-A and ICA median levels were similar in both groups. Regardless of the combined analysis performed (ICA/GAD-A, ICA/IA2-A or GAD-A/IA2-A), the prevalence of combined antibody positivity was higher in diabetic patients with than without ATD. In both diabetic populations, ICA and GA-DA were significantly associated (p < 10(-4), and their levels were correlated (r = 0.42, p < 10(-4) and r = 0.584, p < 10(-4) respectively). No significant correlation was seen between IA2-A levels and either ICA or GAD-A titres. It is concluded that Type 1 diabetes mellitus with ATD is characterised by increased persistent humoral islet-related reactivity, particularly directed towards GAD.
胰岛细胞抗体(ICA)的患病率和水平在糖尿病发病后的几年中会下降,但可能会持续存在,尤其是在伴有自身免疫性疾病的患者中。这项横断面研究的目的是调查患有和未患有自身免疫性甲状腺疾病(ATD)的长期糖尿病患者(中位病程:14年;范围5 - 47年)中主要抗β细胞抗体的频率、关联和水平,以考虑与内分泌自身免疫相关的特定抗胰腺免疫特征。患有ATD的糖尿病患者中ICA和谷氨酸脱羧酶(GAD)抗体(GAD - A)的频率均升高(分别为38%对23%,p = 0.03;70%对21%,p < 10⁻⁴)。尽管患有ATD的糖尿病患者中IA2 - A频率有升高趋势,但未见显著差异(37%对26%,p = 0.14)。患有ATD的糖尿病组中GAD中位水平显著更高(15对5单位,p < 10⁻⁴)。两组中IA2 - A和ICA的中位水平相似。无论进行何种联合分析(ICA/GAD - A、ICA/IA2 - A或GAD - A/IA2 - A),患有ATD的糖尿病患者中联合抗体阳性的患病率均高于未患ATD的患者。在这两个糖尿病群体中,ICA和GAD - A均显著相关(p < 10⁻⁴),且它们的水平呈正相关(分别为r = 0.42,p < 10⁻⁴和r = 0.584,p < 10⁻⁴)。IA2 - A水平与ICA或GAD - A滴度之间未见显著相关性。结论是,伴有ATD的1型糖尿病的特征是持续性体液胰岛相关反应性增加,尤其是针对GAD的反应性增加。