Robert J J, Boitard C, Mogenet A, Chevenne D, Roger M, Deschamps I
Département de Diabétologie (Centre de Dépistage et de Diagnostic du Diabète), Hôpital Necker-Enfants-Malades, Paris.
Arch Fr Pediatr. 1991 Jan;48(1):11-7.
In order to study the capacity of the first phase insulin response (FPIR) for predicting insulin-dependent diabetes (IDDM), we have performed one or more intravenous glucose tolerance tests (IVGTT) and determined islet-cell antibodies (ICA) and HLA-types in 220 first degree relatives of IDDM patients (194 siblings, 26 offsprings) aged 2 to 29 years. They were prospectively followed for periods ranging from 18 months to 8 years. The immunological and metabolic changes in 9 subjects who have developed IDDM or impaired glucose tolerance during the study and in 3 ICA-positive non-diabetic subjects were compared to those in ICA-negative subjects. Although the mean FPIR (1 + 3 min. plasma insulin) was significantly lower in ICA-positive compared with ICA-negative subjects, a unique low FPIR had no predictive value at the individual level. At repeated tests, the two groups followed distinctive evolutive patterns: ICA-negative subjects usually had higher FPIRs at a 2nd test, while FPIRs remained low or still decreased in ICA-positive subjects. Follow-up of subjects at high risk showed good concordance between the different predictive factors: among the 9 subjects who have developed IDDM, 7 had persisting ICA, 8 were HLA-DR3, DR4; the FPIR was consistently low in 3 and low at least once in 4. Progressive loss of the FPIR allowing to predict the time of onset of IDDM, was not observed.
为了研究早期胰岛素反应（FPIR）预测胰岛素依赖型糖尿病（IDDM）的能力，我们对220名年龄在2至29岁的IDDM患者的一级亲属（194名兄弟姐妹，26名子女）进行了一次或多次静脉葡萄糖耐量试验（IVGTT），并测定了胰岛细胞抗体（ICA）和HLA类型。对他们进行了为期18个月至8年的前瞻性随访。将研究期间发生IDDM或糖耐量受损的9名受试者以及3名ICA阳性非糖尿病受试者的免疫和代谢变化与ICA阴性受试者的变化进行了比较。尽管ICA阳性受试者的平均FPIR（1 + 3分钟血浆胰岛素）显著低于ICA阴性受试者，但单独一次低FPIR在个体水平上没有预测价值。在重复测试中，两组呈现出不同的演变模式：ICA阴性受试者在第二次测试时通常具有较高的FPIR，而ICA阳性受试者的FPIR保持较低或仍在下降。对高危受试者的随访显示不同预测因素之间具有良好的一致性：在9名发生IDDM的受试者中，7名持续存在ICA，8名是HLA-DR3、DR4；3名受试者的FPIR持续较低，4名受试者至少有一次FPIR较低。未观察到FPIR的逐渐丧失可用于预测IDDM的发病时间。
