Raile K, Noelle V, Landgraf R, Schwarz H P
Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
Exp Clin Endocrinol Diabetes. 2001;109(8):393-6. doi: 10.1055/s-2001-18991.
To evaluate clinical and immunological factors that are associated with lipodystrophy, i.e. lipoatrophy and lipohypertrophy, in diabetic children and adolescents.
We investigated in a cross-sectional study 112 children and adolescents (age 1.1-19.1 yrs.) with type 1 diabetes. To grade lipodystrophy, we developed a clinical score ranging from normal (grade 0), moderate hypertrophy of subcutaneous tissue (grade 1), severe hypertrophy with increased density of tissue (grade 2) to lipoatrophy (grade 3). In all children, grade of lipodystrophy, antibodies against insulin (IA) or beta cell antigens (IA-2 and GAD) and clinical parameters were documented.
The antibodies against insulin (IA) increased significantly after diabetes manifestation and initiation of insulin treatment, while beta cell specific antibodies (IA-2, GAD) did not. Lipoatrophy (grade 3) was seen in 4 children, severe lipohypertrophy (grade 2) in 18 and moderate lipohypertrophy (grade 1) in 27 children. No alteration of injection sites was found in 63 children. Amongst clinical and immunological parameters, IA levels were significantly associated with hypertrophy or atrophy of injection sites.
The strong association of lipoatrophy and lipohypertrophy with insulin antibodies might suggest that autoimmune phenomena with insulin play a role in the development of both. Despite an association of IA and lipodystrophy in type 1 diabetic children, the causal link between the two remains unproven and requires further longitudinal exploration.
评估与糖尿病儿童及青少年脂肪营养不良（即脂肪萎缩和脂肪肥大）相关的临床和免疫因素。
我们对112例1型糖尿病儿童及青少年（年龄1.1 - 19.1岁）进行了一项横断面研究。为了对脂肪营养不良进行分级，我们制定了一个临床评分，范围从正常（0级）、皮下组织中度肥大（1级）、组织密度增加的重度肥大（2级）到脂肪萎缩（3级）。记录了所有儿童的脂肪营养不良分级、抗胰岛素抗体（IA）或β细胞抗原抗体（IA - 2和GAD）以及临床参数。
糖尿病发病并开始胰岛素治疗后，抗胰岛素抗体（IA）显著增加，而β细胞特异性抗体（IA - 2、GAD）则没有。4例儿童出现脂肪萎缩（3级），18例出现重度脂肪肥大（2级），27例出现中度脂肪肥大（1级）。63例儿童未发现注射部位改变。在临床和免疫参数中，IA水平与注射部位的肥大或萎缩显著相关。
脂肪萎缩和脂肪肥大与胰岛素抗体的强烈关联可能表明胰岛素相关的自身免疫现象在两者的发生中起作用。尽管1型糖尿病儿童中IA与脂肪营养不良有关联，但两者之间的因果关系仍未得到证实，需要进一步的纵向研究。
