Bosi E, Molteni L, Radaelli M G, Folini L, Fermo I, Bazzigaluppi E, Piemonti L, Pastore M R, Paroni R
General Medicine, Diabetes and Endocrinology Unit, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
Diabetologia. 2006 Dec;49(12):2824-7. doi: 10.1007/s00125-006-0465-3. Epub 2006 Oct 7.
AIMS/HYPOTHESIS: Recent observations have shown subclinical intestinal abnormalities in human type 1 diabetes. Whether these are related to the pathogenetic process or secondary to the diabetes remains to be clarified. The aim of this study was to investigate this issue by examining intestinal permeability to sugars in subjects at different stages of type 1 diabetes: preclinical, new-onset and long-term established disease.
Eighty-one subjects with islet autoimmunity (18 preclinical, 28 new-onset and 35 long-term type 1 diabetes) and 40 healthy control subjects were investigated by a lactulose-mannitol test, consisting of oral administration of the two sugars and measurement of their urinary excretion.
All groups of subjects with islet autoimmunity showed an increase in intestinal permeability (p < or = 0.009 vs controls) to the disaccharide lactulose, indicative of a damaged barrier, but a similar permeability to the monosaccharide mannitol (NS vs controls), indicative of an integral surface mucosa; consequently there was an increase in the lactulose:mannitol excretion ratio (p < or = 0.025 vs controls).
CONCLUSIONS/INTERPRETATION: These findings indicate the presence of a subclinical enteropathy associated with type 1 diabetes that is already detectable before clinical onset of the disease, and suggest that the small intestine is an organ participating in the pathogenetic process of type 1 diabetes.
目的/假设：最近的观察结果显示，1型糖尿病患者存在亚临床肠道异常。这些异常是与发病机制相关还是继发于糖尿病仍有待阐明。本研究的目的是通过检测1型糖尿病不同阶段（临床前期、新发和长期患病）患者肠道对糖类的通透性来探讨这一问题。
对81例胰岛自身免疫患者（18例临床前期、28例新发和35例长期1型糖尿病患者）和40例健康对照者进行乳果糖-甘露醇试验，试验包括口服这两种糖类并测量其尿排泄量。
所有胰岛自身免疫患者组对双糖乳果糖的肠道通透性均增加（与对照组相比，p≤0.009），表明屏障受损，但对单糖甘露醇的通透性与对照组相似（无显著性差异），表明表面黏膜完整；因此，乳果糖：甘露醇排泄率增加（与对照组相比，p≤0.025）。
结论/解读：这些发现表明，1型糖尿病患者存在与疾病相关的亚临床肠病，在疾病临床发作前即可检测到，并提示小肠是参与1型糖尿病发病机制的器官。
