Maclaren N
Department of Pathology and Laboratory Medicine, U of Florida College of Medicine, Gainesville.
Ann Allergy. 1992 Jan;68(1):5-9.
Insulin-dependent diabetes is an autoimmune disease that may be becoming more prevalent. It has a polygenic mode of inheritance with a major gene being present in the HLA DQ locus on chromosome 6. Inferential data suggest that environmental factors may be important to genetic penetrance albeit we still lack proof for involvement of often maligned viruses. Patients with IDD and their families are predisposed to organ-specific autoimmunities which should be routinely screened for. Autoantibodies to insulin, to a beta cell cytoplasmic lipid containing moiety and to a beta cell protein of 64KDa, which is believed to be the GABA forming enzyme GAD, can be used to predict IDD among relatives and probably the general population as well. Immunosuppressive therapy can modify the course of IDD after diagnosis and should be able to delay the clinical onset if given before diagnosis. Rigorous insulin therapy should also be given as needed to control hyperglycemia and avoid glucose toxicity to the islets. Such trials are now underway.
胰岛素依赖型糖尿病是一种可能正变得更加普遍的自身免疫性疾病。它具有多基因遗传模式，主要基因位于6号染色体上的HLA DQ位点。推断数据表明环境因素可能对基因外显率很重要，尽管我们仍缺乏证据证明经常被诟病的病毒参与其中。胰岛素依赖型糖尿病患者及其家族易患器官特异性自身免疫性疾病，对此应进行常规筛查。针对胰岛素、β细胞含细胞质脂质部分以及一种64kDa的β细胞蛋白（据信是形成γ-氨基丁酸的酶GAD）的自身抗体，可用于预测亲属以及可能普通人群中的胰岛素依赖型糖尿病。免疫抑制疗法在诊断后可改变胰岛素依赖型糖尿病的病程，如果在诊断前给予，应该能够延迟临床发病。还应根据需要进行严格的胰岛素治疗，以控制高血糖并避免葡萄糖对胰岛的毒性。此类试验正在进行中。
