Imagawa A, Hanafusa T, Tamura S, Moriwaki M, Itoh N, Yamamoto K, Iwahashi H, Yamagata K, Waguri M, Nanmo T, Uno S, Nakajima H, Namba M, Kawata S, Miyagawa J I, Matsuzawa Y
Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan.
Diabetes. 2001 Jun;50(6):1269-73. doi: 10.2337/diabetes.50.6.1269.
To better understand the pathogenesis of type 1 diabetes, we have developed pancreatic biopsy under laparoscope for recent-onset type 1 diabetic patients. The patients included 29 acute-onset type 1 diabetic patients, 5 latent-onset type 1 diabetic patients, and 1 type 2 diabetic patient. Their median age was 28 years, and the duration of diabetes at the time of biopsy was approximately 3 months. In 31 of 35 patients, we could obtain the pancreas tissue by punching. No serious complications, such as heavy bleeding, peritonitis, or pancreatitis, have been experienced. Pneumoderma was observed in two patients, and abdominal dull pain had continued for 2 days in two patients. However, special treatment was not necessary for these complications. T-cell-predominant infiltration to islets (insulitis) and hyperexpression of major histocompatibility complex class I antigens on islet cells were the two major findings and were observed in 17 of 29 recent-onset type 1 diabetic patients. These findings could be regarded as evidence of immune attack against beta-cells, and their presence was closely correlated with the presence of either anti-GAD or anti-IA-2 antibodies (P = 0.02). In conclusion, pancreatic biopsy under laparoscope is a safe procedure without serious complications, according to our findings, for detecting in situ autoimmune phenomenon in recent-onset type 1 diabetic patients.
为了更好地理解1型糖尿病的发病机制，我们为近期发病的1型糖尿病患者开发了腹腔镜下胰腺活检技术。患者包括29例急性起病的1型糖尿病患者、5例隐匿起病的1型糖尿病患者和1例2型糖尿病患者。他们的中位年龄为28岁，活检时糖尿病病程约3个月。35例患者中有31例通过穿刺获取了胰腺组织。未出现严重并发症，如大出血、腹膜炎或胰腺炎。有2例患者出现皮下气肿，2例患者腹部隐痛持续了2天。然而，这些并发症无需特殊治疗。胰岛以T细胞为主的浸润（胰岛炎）和胰岛细胞上主要组织相容性复合体I类抗原的高表达是两个主要发现，在29例近期发病的1型糖尿病患者中有17例观察到。这些发现可被视为针对β细胞免疫攻击的证据，它们的存在与抗谷氨酸脱羧酶（GAD）抗体或抗胰岛细胞抗原2（IA-2）抗体的存在密切相关（P = 0.02）。总之，根据我们的研究结果，腹腔镜下胰腺活检是一种安全的操作，无严重并发症，可用于检测近期发病的1型糖尿病患者的原位自身免疫现象。
