Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
J Clin Endocrinol Metab. 2017 Sep 1;102(9):3162-3171. doi: 10.1210/jc.2016-3735.
With prolonged life expectancy, we often encounter patients with elderly-onset type 2 diabetes mellitus (eT2DM). Although the clinical features of eT2DM are suggested to be different from those in patients with middle-age-onset type 2 diabetes mellitus (mT2DM), the islet pathologic features in eT2DM have not been addressed.
We attempted to characterize the pancreatic pathology in eT2DM and sought its clinical implications.
Pancreata from 13 young nondiabetic (age, 20 to 29 years), 27 patients with mT2DM (age, 45 to 87 years), 22 middle-age subjects without T2DM, 15 subjects with eT2DM (age, 85 to 100 years), and 30 elderly subjects without T2DM were investigated. Together with conventional microscopic observations, morphometric analysis on the islet, islet endocrine cells, and amyloid deposition was conducted on immunostained sections.
The estimated age of diabetes onset was 80.8 ± 1.4 years (mean ± standard error) in the eT2DM group and that of the mT2DM group was 48.3 ± 2.4 years. The pancreatic weight was nearly 50% less in the eT2DM group than in the other groups, showing duct obstruction with epithelial hyperplasia, marked acinar atrophy, fibrosis, and amyloid deposition in the islet. The islet mass was significantly reduced in the eT2DM group. The amyloid volume density correlated inversely with the β-cell volume density but not with the body mass index in the eT2DM group. Laboratory data showed mild elevation of serum amylase in the eT2DM group, although clinical signs and symptoms of pancreatitis were not apparent.
eT2DM is distinct from mT2DM and characterized by pancreas atrophy, ductal lesions, and amyloid deposition.
随着预期寿命的延长，我们经常会遇到老年起病 2 型糖尿病（eT2DM）患者。虽然 eT2DM 的临床特征与中年起病 2 型糖尿病（mT2DM）患者不同，但 eT2DM 的胰岛病理特征尚未得到解决。
我们试图描述 eT2DM 的胰腺病理学特征，并探讨其临床意义。
研究了 13 例年轻非糖尿病患者（年龄 20 至 29 岁）、27 例 mT2DM 患者（年龄 45 至 87 岁）、22 例中年非糖尿病患者、15 例 eT2DM 患者（年龄 85 至 100 岁）和 30 例老年非糖尿病患者的胰腺。除了常规显微镜观察外，还对免疫染色切片进行胰岛、胰岛内分泌细胞和淀粉样物质沉积的形态计量分析。
eT2DM 组糖尿病发病年龄估计为 80.8 ± 1.4 岁（均值 ± 标准误差），mT2DM 组为 48.3 ± 2.4 岁。eT2DM 组的胰腺重量比其他组低近 50%，表现为导管阻塞伴上皮增生、明显的腺泡萎缩、纤维化和胰岛淀粉样物质沉积。eT2DM 组胰岛质量明显减少。eT2DM 组的淀粉样物质体积密度与β细胞体积密度呈负相关，但与体重指数无关。实验室数据显示 eT2DM 组血清淀粉酶轻度升高，尽管没有明显的胰腺炎临床症状和体征。
eT2DM 与 mT2DM 不同，其特征为胰腺萎缩、导管病变和淀粉样物质沉积。
