Prázný M, Skrha J, Límanová Z, Vanícková Z, Hilgertová J, Prázná J, Jaresová M, Stríz I
Third Department of Internal Medicine, First Faculty of Medicine, Charles University, U nemocnice 1, 128 08 Prague 2, Czech Republic.
Physiol Res. 2005;54(1):41-48. doi: 10.33549/physiolres.930544.
As an autoimmune disease, type 1 diabetes mellitus (DM) can be associated with other autoimmune disorders. The aim of this study was to detect subclinically associated autoimmune thyroid disease, coeliac disease, and Addison's disease. The presence of autoantibodies was evaluated with special regard to the control of diabetes and to the clinical status of the patient. Fifty-one type 1 diabetic patients (22 men, 29 women, mean age 37+/-11 years, mean duration of diabetes 16+/-13 years) were included into this study. Specific antibodies to islet antigens--glutamic acid decarboxylase (GAD65), protein thyrosine phosphatase IA-2alpha, and to thyroid autoantigens--thyroid microsomal peroxidase (TPO) and thyroglobulin (TG) and also thyroid stimulating hormone (TSH) were measured by RIA. Autoantigens of the small intestine--tissue transglutaminase autoantibodies (ATTG), IgA and IgG antibodies to gliadin (AGA-IgA, AGA-IgG) were evaluated by ELISA. Endomysial autoantibodies (EMA) and adrenal cortex antibodies (ACA) were detected by indirect immunofluorescence microscopy. Eleven new cases of thyreopathy (22 % of patients) were detected by the assessment of thyroid autoantibodies and TSH. Two new cases of thyreotoxicosis were diagnosed during the study. Coeliac disease was diagnosed in at least two cases. Addison's disease was not diagnosed, although the ACA were positive in two patients. No influence of single or combined autoantibody positivity on the control of diabetes was found if normal organ function was preserved. In both patients with thyreotoxicosis the control of diabetes was worsened and improved after treatment. The screening of autoantibodies in type 1 diabetic patients could reveal subclinical cases of AITD or coeliac disease. Subclinical forms of these disorders have no influence on diabetes control. However, impaired organ function may be associated with the worsened control of diabetes as we demonstrated on two newly diagnosed cases of thyreotoxicosis. We suggest the need for the follow-up of patients with positive autoantibodies because further deterioration of the respective organs can be expected.
作为一种自身免疫性疾病，1型糖尿病（DM）可能与其他自身免疫性疾病相关。本研究的目的是检测亚临床相关的自身免疫性甲状腺疾病、乳糜泻和艾迪生病。特别针对糖尿病的控制情况以及患者的临床状况评估自身抗体的存在情况。51例1型糖尿病患者（22例男性，29例女性，平均年龄37±11岁，平均糖尿病病程16±13年）被纳入本研究。通过放射免疫分析法（RIA）检测胰岛抗原——谷氨酸脱羧酶（GAD65）、蛋白酪氨酸磷酸酶IA - 2α的特异性抗体，以及甲状腺自身抗原——甲状腺微粒体过氧化物酶（TPO）、甲状腺球蛋白（TG）和促甲状腺激素（TSH）。通过酶联免疫吸附测定法（ELISA）评估小肠自身抗原——组织转谷氨酰胺酶自身抗体（ATTG）、抗麦胶蛋白IgA和IgG抗体（AGA - IgA、AGA - IgG）。通过间接免疫荧光显微镜检测肌内膜自身抗体（EMA）和肾上腺皮质抗体（ACA）。通过评估甲状腺自身抗体和TSH检测到11例新的甲状腺疾病病例（占患者的22%）。在研究期间诊断出2例新的甲状腺毒症病例。至少2例被诊断为乳糜泻。尽管2例患者的ACA呈阳性，但未诊断出艾迪生病。如果器官功能保持正常，未发现单一或联合自身抗体阳性对糖尿病控制有影响。在2例甲状腺毒症患者中，糖尿病控制在治疗后恶化然后改善。对1型糖尿病患者进行自身抗体筛查可发现自身免疫性甲状腺疾病（AITD）或乳糜泻的亚临床病例。这些疾病的亚临床形式对糖尿病控制无影响。然而，正如我们在2例新诊断的甲状腺毒症病例中所证明的，器官功能受损可能与糖尿病控制恶化相关。我们建议对自身抗体阳性的患者进行随访，因为预计相应器官会进一步恶化。
