Moncada E
Departamento de Endocrinología y Metabolismo, Universidad de Navarra, Pamplona, España.
Rev Esp Fisiol. 1989;45 Suppl:301-8.
Differences between Type 1 and Type 2 Diabetes Mellitus are briefly outlined with special emphasis on the immune mechanism in the development of juvenile diabetes. Autoimmune nature of Type 1 diabetes is based on: association with genetic markers of histocompatibility mainly with the DR3 and DR4 haplotypes of the HLA system; anomalies of the humoral and cellular immunity present in a significant percentage of Type 1 diabetic patients, its association with other autoimmune diseases; the histological features of the affected pancreas and the prevention of experimental diabetes by immunosuppression. Trials on immunotherapy with immunosuppressors (Cyclosporine A and Azathioprine) and immunomodulators (Thymic hormone) were able to achieve a 50-60% index of clinical and functional remission for more than one year. With Thymic hormone and Azathioprine in combined administration the glycemic control and residual beta-cell function one year after stopping immunotherapy exhibited positive comparative results. Other trials on immunotherapy are outlined. Side effects of immunosuppression and future prospectives for immune approaches in Type 1 diabetes are commented.
简要概述了1型和2型糖尿病之间的差异，特别强调了青少年糖尿病发病过程中的免疫机制。1型糖尿病的自身免疫性质基于以下几点：与组织相容性基因标记相关，主要与HLA系统的DR3和DR4单倍型相关；相当比例的1型糖尿病患者存在体液和细胞免疫异常，它与其他自身免疫性疾病相关；受影响胰腺的组织学特征以及通过免疫抑制预防实验性糖尿病。使用免疫抑制剂（环孢素A和硫唑嘌呤）和免疫调节剂（胸腺激素）进行免疫治疗的试验能够在一年多的时间内实现50%-60%的临床和功能缓解率。联合使用胸腺激素和硫唑嘌呤时，停止免疫治疗一年后的血糖控制和残余β细胞功能显示出积极的比较结果。概述了其他免疫治疗试验。对免疫抑制的副作用以及1型糖尿病免疫治疗方法的未来前景进行了评论。
