移民到瑞典的 1 型糖尿病患者增加了其本土糖尿病的发病风险，且与瑞典患者在 HLA 类型和胰岛自身抗体方面存在差异。

Type 1 diabetes patients born to immigrants to Sweden increase their native diabetes risk and differ from Swedish patients in HLA types and islet autoantibodies.

机构信息

Department of Clinical Sciences, Lund University, Malmö, Sweden.

出版信息

Pediatr Diabetes. 2010 Dec;11(8):513-20. doi: 10.1111/j.1399-5448.2010.00637.x.

DOI:10.1111/j.1399-5448.2010.00637.x

PMID:20337975

Abstract

AIM

To determine whether type 1 diabetes mellitus (T1DM) patients, having parents who immigrated to Sweden, have increased T1DM risk before 18 yr compared with countries of origin. We also determined whether they have different human leukocyte antigen (HLA) genetic markers and islet autoantibodies at diagnosis compared with Swedish patients.

METHODS

A total of 1988 (53% males) newly diagnosed and confirmed T1DM patients <18 yr registered within the Better Diabetes Diagnosis (BDD) study (May 2005 to September 2008) were included. Participants were classified into three groups: Swedish, non-Swedish, and Mixed-origin patients according to country of origin of two generations (parents and grandparents). These groups were compared with respect to T1DM HLA markers and islet autoantibodies [glutamic acid decarboxylase autoantibodies (GAD65Ab), insulin autoantibodies (IAA), and islet antigen-2 autoantibodies (IA-2Ab)].

RESULTS

Only 30 (1.5%) patients were born outside Sweden. Swedish patients constituted 66%, non-Swedish patients 8%, Mixed origins 17%, and 9% were of uncertain origin. Confirmed T1DM in patients within the study was 22 (95% CI: 21-23) patients/10(5)/yr rate for Swedish patients compared with 14 (95% CI: 13-15) among non-Swedish patients. The HLA-DQ8 haplotype (p < 0.0001) and DQ2/8 genotype (p < 0.02) predominated among Swedish compared with non-Swedish patients. In contrast, DQ2 was the most frequent haplotype among non-Swedish patients [OR = 1.5 (95% CI: 1.0-2.0), p < 0.04]. Multiple (≥2) autoantibodies (p < 0.04) and specifically IA-2Ab (p < 0.001) were most prevalent among the Swedish patients. Multiple autoantibodies were associated with DQ8 among the Swedish patients only (p < 0.001).

CONCLUSION

Patients born to parents who had immigrated to the high T1DM incidence environment of Sweden have, compared with Swedish patients, more frequent HLA-DQ2 genetic markers and are diagnosed more often with GAD65Ab.

摘要

目的

确定患有移民到瑞典的父母的 1 型糖尿病（T1DM）患者在 18 岁之前患 T1DM 的风险是否高于原籍国。我们还确定了与瑞典患者相比，他们在诊断时是否具有不同的人类白细胞抗原（HLA）遗传标志物和胰岛自身抗体。

方法

本研究共纳入了 1988 名（53%为男性）新诊断并确诊为 18 岁以下 T1DM 的患者（2005 年 5 月至 2008 年 9 月期间参加了更好的糖尿病诊断研究（BDD））。参与者根据两代人（父母和祖父母）的原籍国分为三组：瑞典人、非瑞典人和混合起源人群。这些组在 T1DM HLA 标志物和胰岛自身抗体[谷氨酸脱羧酶自身抗体（GAD65Ab）、胰岛素自身抗体（IAA）和胰岛抗原-2 自身抗体（IA-2Ab）]方面进行了比较。

结果

仅有 30 名（1.5%）患者出生在瑞典以外的地方。瑞典患者占 66%，非瑞典患者占 8%，混合起源患者占 17%，9%的患者原籍国不确定。研究中确诊的 T1DM 患者中，瑞典患者的发病率为 22（95%可信区间：21-23）例/10 例（5 例/年），而非瑞典患者为 14（95%可信区间：13-15）例/10 例。与非瑞典患者相比，瑞典患者中 HLA-DQ8 单倍型（p<0.0001）和 DQ2/8 基因型（p<0.02）更为常见。相反，非瑞典患者中最常见的单倍型是 DQ2（OR=1.5（95%可信区间：1.0-2.0），p<0.04）。与瑞典患者相比，非瑞典患者中存在多种（≥2 种）自身抗体（p<0.04）和特定的 IA-2Ab（p<0.001）更为常见。只有在瑞典患者中，多种自身抗体与 DQ8 相关（p<0.001）。