Laadhar Lilia, Harzallah Fatma, Zitouni Mondher, Kallel-Sellami Maryam, Fekih Moncef, Kaabachi Naziha, Slimane Hádia, Makni Sondès
Immunology Department, La Rabta Hospital, Al Manar University Tunis, Tunisia.
Exp Diabetes Res. 2011;2011:964160. doi: 10.1155/2011/964160. Epub 2011 Mar 2.
We aimed to characterize the different subgroups of ketosis-prone diabetes (KPD) in a sample of Tunisian patients using the Aβ scheme based on the presence or absence of β-cell autoantibodies (A+ or A-) and β-cell functional reserve (β+ or β-) and we investigated whether HLA class II alleles could contribute to distinct KPD phenotypes. We enrolled 43 adult patients with a first episode of ketosis. For all patients we evaluated clinical parameters, β-cell autoimmunity, β-cell function and HLA class II alleles. Frequency distribution of the 4 subgroups was 23.3% A+β-, 23.3% A-β-, 11.6% A+β+ and 41.9% A-β+. Patients from the group A+β- were significantly younger than those from the group A-β- (P = .002). HLA susceptibility markers were significantly more frequent in patients with autoantibodies (P = .003). These patients also had resistance alleles but they were more frequent in A+β+ than A+β- patients (P = .04). Insulin requirement was not associated to the presence or the absence of HLA susceptibility markers. HLA class II alleles associated with susceptibility to autoimmune diabetes have not allowed us to further define Tunisian KPD groups. However, high prevalence of HLA resistance alleles in our patients may reflect a particular genetic background of Tunisian KPD population.
我们旨在利用基于β细胞自身抗体（A+或A-）和β细胞功能储备（β+或β-）的Aβ方案，对一组突尼斯患者样本中的酮症倾向糖尿病（KPD）不同亚组进行特征描述，并研究HLA II类等位基因是否有助于区分不同的KPD表型。我们招募了43例首次出现酮症的成年患者。对所有患者，我们评估了临床参数、β细胞自身免疫、β细胞功能和HLA II类等位基因。4个亚组的频率分布分别为：A+β-占23.3%，A-β-占23.3%，A+β+占11.6%，A-β+占41.9%。A+β-组的患者显著比A-β-组的患者年轻（P = 0.002）。HLA易感性标记在有自身抗体的患者中显著更常见（P = 0.003）。这些患者也有抗性等位基因，但在A+β+患者中比A+β-患者中更常见（P = 0.04）。胰岛素需求与HLA易感性标记的有无无关。与自身免疫性糖尿病易感性相关的HLA II类等位基因未能使我们进一步明确突尼斯KPD组。然而，我们患者中HLA抗性等位基因的高患病率可能反映了突尼斯KPD人群的特定遗传背景。
