Medical Division, Maccabi Healthcare Services, Tel Aviv, 68125, Israel.
Pediatr Diabetes. 2012 Nov;13(7):583-6. doi: 10.1111/j.1399-5448.2012.00886.x. Epub 2012 Jul 6.
Infectious diseases have been associated with increased risk of type 1 diabetes (T1D). The objective of this case-crossover was to quantify the role of infectious diseases as triggers for T1D, 1 and 2 yr preceding disease diagnosis.
All children aged 2-18 yr diagnosed with T1D between 2004 and 2009 among a two million member Israeli healthcare organization were identified (n = 368). For each patient, visits to physicians with symptomatic infectious diseases during 1 and 2 yr before T1D diagnosis were collected and compared. A similar analysis was conducted in a population of non-diabetic members matched on exact date of birth, sex and socioeconomic status (n = 307).
The rate of systemic viral infections was significantly higher in the year before T1D onset, as compared to the prior year [27 vs. 7%, respectively, odds ratio (OR) = 4.7, 95% confidence intervals (CI): 2.9-8.2]. This difference was most significant among patients diagnosed with T1D at the age of 2 to 6 (5 vs. 46%, respectively, OR = 27.0, 95% CI: 4.5-1105.4). Among non-T1D patients of the same age group, no difference was found in the proportion of patients with viral diseases 1 and 2 yr prior to T1D diagnosis (44 vs. 49%, respectively, OR = 0.8, 95% CI: 0.4-1.6). This unique association was limited only to viral diseases and to patients diagnosed with T1D at young age.
Our results indicate that T1D occurring in toddlers is characterized with a relatively low incidence of viral disease 2 yr prior to diagnosis and a much higher incidence in the subsequent year.
传染病与 1 型糖尿病（T1D）风险增加有关。本病例交叉研究的目的是量化传染病作为 T1D 发病前 1 年和 2 年的诱因的作用。
在 2004 年至 2009 年间，在一个拥有 200 万成员的以色列医疗保健组织中，确定了所有 2-18 岁被诊断为 T1D 的儿童（n=368）。为每位患者收集了在 T1D 诊断前 1 年和 2 年期间因症状性传染病就诊的信息，并与按出生日期、性别和社会经济状况匹配的非糖尿病患者（n=307）进行了比较。
与前一年相比，T1D 发病前一年全身性病毒感染的发生率明显更高[分别为 27%和 7%，比值比（OR）=4.7，95%置信区间（CI）：2.9-8.2]。在 2 至 6 岁被诊断为 T1D 的患者中，这种差异最为显著[分别为 5%和 46%，OR=27.0，95%CI：4.5-1105.4]。在相同年龄组的非 T1D 患者中，T1D 诊断前 1 年和 2 年病毒病患者的比例无差异[分别为 44%和 49%，OR=0.8，95%CI：0.4-1.6]。这种独特的关联仅局限于病毒疾病和年龄较小的 T1D 患者。
我们的结果表明，在幼儿中发生的 T1D 表现为诊断前 2 年病毒病的发病率相对较低，而随后一年的发病率则较高。
