Ziegler A G, Ziegler R, Vardi P, Jackson R A, Soeldner J S, Eisenbarth G S
Joslin Diabetes Center, Brigham and Women's Hospital, Boston, MA 02215.
Diabetes. 1989 Oct;38(10):1320-5. doi: 10.2337/diab.38.10.1320.
Cytoplasmic islet cell antibody-negative (ICA-; less than 20 Juvenile Diabetes Foundation units, n = 1670) and ICA+ (n = 42) first-degree relatives of type I (insulin-dependent) diabetic individuals were studied for competitive insulin autoantibodies (CIAAs) with a radioassay. Overall, 3.7% of first-degree relatives (64 of 1712) were CIAA+. Of ICA- relatives, 2.7% (45 of 1670) exceeded the upper limit of our normal CIAA range (greater than 39 nU/ml), and 45% (19 of 42) of ICA+ relatives exceeded this normal range. Follow-up serums for repeat CIAA determination have been obtained from 16 of the nondiabetic CIAA+/ICA- individuals (time between samples, 0.4-5.8 yr). Fourteen of these 16 (87%) CIAA+/ICA- relatives were found to still be positive on follow-up, and 2 of the relatives who were positive on the first determination were negative on their follow-up test. With a mean follow-up of approximately 2 yr, 4 of 45 (9%) of the CIAA+/ICA- relatives, 5 of 23 (22%) of the ICA+/CIAA- relatives, and 12 of 19 (63%) of the CIAA+/ICA+ relatives developed diabetes. Life-table analysis indicated that, overall, 53% of CIAA+ relatives become diabetic after 5 yr of follow-up versus 65% of ICA+ relatives. Also by life-table analysis, the predicted risk after 5 yr of follow-up for progression to diabetes is 17% for CIAA+/ICA- relatives, 42% for ICA+/CIAA- relatives, and 77% for CIAA+/ICA+ relatives. The highest rate of progression to diabetes was found in ICA+ relatives with CIAA levels greater than 150 nU/ml (100% projected to be diabetic within 5 yr, P less than .008 vs. ICA+/CIAA- relatives).
采用放射免疫分析法对1型（胰岛素依赖型）糖尿病患者的1670名细胞质胰岛细胞抗体阴性（ICA-；小于20个青少年糖尿病基金会单位）和42名ICA阳性的一级亲属进行了竞争性胰岛素自身抗体（CIAA）研究。总体而言，1712名一级亲属中有3.7%（64名）为CIAA阳性。在ICA阴性的亲属中，2.7%（1670名中的45名）超过了我们正常CIAA范围的上限（大于39 nU/ml），而ICA阳性亲属中有45%（42名中的19名）超过了这个正常范围。已从16名非糖尿病CIAA阳性/ICA阴性个体中获取了用于重复CIAA测定的随访血清（样本间隔时间为0.4 - 5.8年）。这16名CIAA阳性/ICA阴性亲属中有14名（87%）在随访时仍为阳性，首次测定为阳性的2名亲属在随访测试时为阴性。平均随访约2年，CIAA阳性/ICA阴性亲属中的45名中有4名（9%）、ICA阳性/CIAA阴性亲属中的23名中有5名（22%）以及CIAA阳性/ICA阳性亲属中的19名中有12名（63%）患了糖尿病。生命表分析表明，总体而言，随访5年后，53%的CIAA阳性亲属患糖尿病，而ICA阳性亲属为65%。同样通过生命表分析，随访5年后进展为糖尿病的预测风险，CIAA阳性/ICA阴性亲属为17%，ICA阳性/CIAA阴性亲属为42%，CIAA阳性/ICA阳性亲属为77%。在CIAA水平大于150 nU/ml的ICA阳性亲属中，糖尿病进展率最高（预计5年内100%患糖尿病，与ICA阳性/CIAA阴性亲属相比，P小于0.008）。
