Mandrup-Poulsen T, Nerup J, Stiller C R, Marner B, Bille G, Heinrichs D, Martell R, Dupre J, Keown P A, Jenner M R
Lancet. 1985 Mar 16;1(8429):599-602. doi: 10.1016/s0140-6736(85)92143-9.
In 68 newly diagnosed patients with insulin-dependent diabetes mellitus (IDDM) whose treatment included cyclosporin (CyA) the prevalence and mean titre of islet cell cytoplasmic antibodies (ICA) fell faster than they did in the 56 who received only insulin. However, in the CyA-treated patients the prevalence or titre of ICA at diagnosis did not correlate with beta-cell function as measured by glucagon-stimulated C-peptide levels; improvement and recovery of beta-cell function after 30 days of CyA therapy occurred despite the continued presence of ICA; and CyA-induced remission of IDDM (ie, glucagon stimulated plasma C-peptide levels greater than 0.6 pmol/ml) was not predicted by nor coincident with disappearance of ICA. Therefore, although CyA therapy was associated with a higher than expected frequency of remission and faster disappearance of ICA, the two observations were not temporally and may not be causally related. ICA should not be used to identify the target population for or to predict response to immunosuppressive therapy. The contribution of ICA to the pathogenesis of beta-cell destruction in IDDM needs serious re-examination.
在68例新诊断的胰岛素依赖型糖尿病（IDDM）患者中，其治疗包括环孢素（CyA），胰岛细胞胞浆抗体（ICA）的患病率和平均滴度下降速度比仅接受胰岛素治疗的56例患者更快。然而，在接受CyA治疗的患者中，诊断时ICA的患病率或滴度与通过胰高血糖素刺激的C肽水平测量的β细胞功能无关；尽管ICA持续存在，但在CyA治疗30天后β细胞功能仍有改善和恢复；并且ICA的消失既不能预测也不与CyA诱导的IDDM缓解（即，胰高血糖素刺激的血浆C肽水平大于0.6 pmol/ml）同时发生。因此，尽管CyA治疗与高于预期的缓解频率和ICA更快消失相关，但这两个观察结果在时间上没有关联，可能也没有因果关系。ICA不应用于确定免疫抑制治疗的目标人群或预测其反应。ICA在IDDM中β细胞破坏发病机制中的作用需要认真重新审视。
