Gregory R, Tattersall R B
Department of Diabetes, University Hospital, Nottingham, UK.
Diabet Med. 1991 Jan;8(1):72-5. doi: 10.1111/j.1464-5491.1991.tb01519.x.
It has been suggested that screening all patients with diabetes diagnosed in later life for islet cell antibodies (ICA) would help predict insulin dependence. We have surveyed the case notes of 55 patients (22 male; ages 37-88 years) who were found to be ICA positive over a 9-year screening period to assess what contribution knowledge of ICA status made to their management. Forty-two patients had been put on insulin (half within 6 months of diagnosis and the rest after up to 6 years). Of the 13 patients not on insulin, six were on diet alone and seven on oral hypoglycaemic agents after a median follow-up of 3 years. In 37 of the 42 patients, insulin treatment was started for clinical rather than immunological reasons (diabetic ketoacidosis, ketonuria, weight loss and/or severe symptoms). Five patients were started on insulin because of ICA status when there was no compelling reason on clinical grounds. Knowledge that seven non-insulin-treated patients were ICA positive made doctors reluctant to discharge them from clinic. The data suggest that routine ICA estimation in this age group is unnecessary, as the decision to treat with insulin is best made on clinical grounds, and ICA estimation can lead to unwarranted insulin treatment, or anxiety in patients and doctors who are aware of a positive result.
有人提出，对所有晚年诊断出的糖尿病患者进行胰岛细胞抗体（ICA）筛查，将有助于预测胰岛素依赖情况。我们查阅了55例患者（22例男性；年龄37 - 88岁）的病历，这些患者在9年的筛查期内被发现ICA呈阳性，以评估ICA状态信息对其治疗管理有何作用。42例患者已开始使用胰岛素（其中一半在诊断后6个月内开始，其余在诊断后长达6年开始）。在13例未使用胰岛素的患者中，6例仅采用饮食控制，7例在中位随访3年后使用口服降糖药。在42例患者中，有37例开始胰岛素治疗是出于临床而非免疫学原因（糖尿病酮症酸中毒、酮尿、体重减轻和/或严重症状）。有5例患者在没有临床紧迫理由的情况下，因ICA状态而开始使用胰岛素。了解到7例未接受胰岛素治疗的患者ICA呈阳性后，医生不愿让他们出院。数据表明，在这个年龄组进行常规ICA检测是不必要的，因为胰岛素治疗的决策最好基于临床依据做出，而ICA检测可能导致不必要的胰岛素治疗，或者使知晓检测结果呈阳性的患者和医生产生焦虑。
