Department of Cellular and Molecular Medicine, University of Bristol, 53 Arley Hill, Bristol BS6 5PJ, UK.
J Mol Endocrinol. 2013 Jul 12;51(1):R1-13. doi: 10.1530/JME-13-0067. Print 2013.
A series of studies have reported a constant global rise in the incidence of type 1 diabetes. Epidemiological and immunological studies have demonstrated that environmental factors may influence the pathogenesis, leading to a cell-mediated pancreatic β-cell destruction associated with humoral immunity. The search for the triggering factor(s) has been going on for the past century, and yet they are still unknown. This review provides an overview of some of the most well-known theories found in the literature: hygiene, viral, vitamin D deficiency, breast milk and cow's milk hypotheses. Although the hygiene hypothesis appears to be the most promising, positive evidence from animal, human and epidemiological studies precludes us from completely discarding any of the other hypotheses. Moreover, due to contrasting evidence in the literature, a single factor is unlikely to cause an increase in the incidence of diabetes all over the world, which suggests that a multifactorial process might be involved. Although the immunological mechanisms are still unclear, there seems to be some overlap between the various hypotheses. It is thought that the emphasis should be shifted from a single to a multifactorial process and that perhaps the 'balance shift' model should be considered as a possible explanation for the rise in the incidence of type 1 diabetes.
一系列研究报告表明，1 型糖尿病的发病率在全球范围内呈持续上升趋势。流行病学和免疫学研究表明，环境因素可能影响发病机制，导致与体液免疫相关的细胞介导的胰岛β细胞破坏。过去一个世纪以来，人们一直在寻找触发因素，但至今仍未找到。本文综述了文献中一些最著名的理论：卫生假说、病毒假说、维生素 D 缺乏假说、母乳和牛奶假说。尽管卫生假说似乎最有希望，但来自动物、人类和流行病学研究的阳性证据使我们无法完全排除任何其他假说。此外，由于文献中存在相互矛盾的证据，单一因素不太可能导致全球范围内糖尿病发病率的增加，这表明可能涉及多种因素的复杂过程。尽管免疫学机制仍不清楚，但各种假说之间似乎存在一些重叠。人们认为，重点应该从单一因素转移到多因素过程，也许“平衡转移”模型可以被认为是解释 1 型糖尿病发病率上升的一种可能解释。
