1型糖尿病患儿未患病兄弟中胰岛细胞抗体频率增加。
Increased frequency of islet cell antibodies in unaffected brothers of children with type 1 diabetes.
作者信息
Eskola Vesa, Vähäsalo Paula, Akerblom Hans K, Knip Mikael
机构信息
University of Tampere Medical School and Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
出版信息
Horm Res. 2003;59(4):195-200. doi: 10.1159/000069327.
AIM
To assess the relation between islet cell antibody (ICA) positivity and demographic characteristics in an extensive series of first-degree relatives of children with type 1 diabetes (T1D).
METHODS
Family members of children diagnosed with T1D before the age of 16 years and attending one of 27 participating paediatric units in Finland taking care of children with diabetes were invited to volunteer for an ICA screening program aimed at identifying individuals eligible for inclusion in the European Nicotinamide Diabetes Intervention Trial (ENDIT). The final series comprised 2,522 first-degree relatives (1,107 males) with a mean age of 20.4 (range 0.1-51.9) years, out of whom 390 were fathers, 622 mothers, 717 brothers, and 793 sisters of affected cases.
RESULTS
Two hundred and four family members (8.1%) tested positive for ICA with levels ranging from 3 to 564 (median 18) Juvenile Diabetes Foundation (JDF) units. One hundred and five relatives (4.2%) had an ICA level of 18 JDF units or more. Males had detectable ICA more often than females (9.6 vs. 6.9%; p = 0.02). Antibody-positive family members under the age of 20 years had higher ICA levels than the older ones [median 18 (range 3-514) JDF units vs. 10 (range 3-564) JDF units; p = 0.008]. Among the adult relatives (>or=20 years of age) antibody-positive females had higher ICA levels than the males [median 10 (range 5-564) JDF units vs. 9 (range 3-130) JDF units; p = 0.04]. Siblings had an increased frequency of high-titre ICA (>or=18 JDF units) when compared to the parents (4.8 vs. 3.2%; p = 0.05). Among siblings, we found a higher frequency of ICA positivity in brothers than in sisters (10.8 vs. 6.9%; p = 0.01), and this was also true for high-titre ICA (6.0 vs. 3.8 %; p = 0.04). Geographically, the highest ICA prevalence was seen among relatives living in the middle of Finland (10.4 vs. 7.2% in the other parts of Finland; p = 0.01).
CONCLUSIONS
These results imply that male gender and young age favour positive ICA reactivity among family members of children with T1D. Siblings test positive for high ICA titres (>or=18 JDF units) more frequently than parents. Accordingly, judged from demographic characteristics, the yield of ICA screening in first-degree relatives would be maximized by targeting young brothers of affected cases.
目的
在大量1型糖尿病（T1D）患儿的一级亲属中评估胰岛细胞抗体（ICA）阳性与人口统计学特征之间的关系。
方法
邀请16岁之前被诊断为T1D且在芬兰27个参与研究的儿科单位之一接受糖尿病治疗的患儿家属自愿参加一项ICA筛查项目，该项目旨在确定有资格纳入欧洲烟酰胺糖尿病干预试验（ENDIT）的个体。最终研究对象包括2522名一级亲属（1107名男性），平均年龄为20.4岁（范围0.1 - 51.9岁），其中390名是患病儿童的父亲，622名是母亲，717名是兄弟，793名是姐妹。
结果
204名家庭成员（8.1%）ICA检测呈阳性，水平范围为3至564（中位数18）青少年糖尿病基金会（JDF）单位。105名亲属（4.2%）的ICA水平为18 JDF单位或更高。男性比女性更常检测到可检测水平的ICA（9.6%对6.9%；p = 0.02）。20岁以下抗体阳性的家庭成员的ICA水平高于年龄较大者[中位数18（范围3 - 514）JDF单位对10（范围3 - 564）JDF单位；p = 0.008]。在成年亲属（≥20岁）中，抗体阳性的女性的ICA水平高于男性[中位数10（范围5 - 564）JDF单位对9（范围3 - 130）JDF单位；p = 0.04]。与父母相比，兄弟姐妹中高滴度ICA（≥18 JDF单位）的频率增加（4.8%对3.2%；p = 0.05）。在兄弟姐妹中，我们发现兄弟中ICA阳性的频率高于姐妹（10.8%对6.9%；p = 0.01），高滴度ICA也是如此（6.0%对3.8%；p = 0.04）。在地理上，芬兰中部地区的亲属中ICA患病率最高（10.4%，芬兰其他地区为7.2%；p = 0.01）。
结论
这些结果表明，男性和年轻年龄有利于T1D患儿家庭成员中ICA反应呈阳性。兄弟姐妹高滴度ICA（≥18 JDF单位）检测呈阳性的频率比父母更高。因此，从人口统计学特征判断，针对患病儿童的年轻兄弟进行ICA筛查，在一级亲属中的筛查收益将最大化。
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