Gilbey S G, Guy R J, Jones H, Vergani D, Watkins P J
Diabet Med. 1986 May;3(3):241-5. doi: 10.1111/j.1464-5491.1986.tb00753.x.
Lymphocytic infiltration of autonomic ganglia found at autopsy and a strong clinical association with iritis suggests that diabetic autonomic neuropathy might have an immunological basis. We measured levels of circulating immune complexes, complement (C3, C4), complement breakdown products (C3d), and insulin antibodies in diabetics with autonomic neuropathy and a history of iritis (n = 17), compared to diabetics of similar age and duration with autonomic neuropathy but no history of iritis (n = 20), and with uncomplicated insulin-dependent diabetics (n = 23), together with normal controls (n = 26). We found higher levels of circulating immune complexes in patients with autonomic neuropathy (irrespective of iritis) compared to normal controls, and differences in C3d levels suggesting complement activation. C4 levels were unexpectedly normal in the diabetics with autonomic neuropathy, in contrast to the uncomplicated insulin-dependent diabetic controls. Insulin antibody levels showed no difference between the three groups of diabetics. These findings suggest that immunological mechanisms may be implicated in the aetiology of diabetic autonomic neuropathy and that further studies are indicated.
尸检发现自主神经节有淋巴细胞浸润，且与虹膜炎有很强的临床关联，这表明糖尿病性自主神经病变可能有免疫学基础。我们测定了有自主神经病变且有虹膜炎病史的糖尿病患者（n = 17）、年龄和病程相似但无虹膜炎病史的自主神经病变糖尿病患者（n = 20）、无并发症的胰岛素依赖型糖尿病患者（n = 23）以及正常对照者（n = 26）的循环免疫复合物、补体（C3、C4）、补体裂解产物（C3d）和胰岛素抗体水平。我们发现，与正常对照相比，自主神经病变患者（无论是否有虹膜炎）的循环免疫复合物水平更高，且C3d水平存在差异提示补体激活。与无并发症的胰岛素依赖型糖尿病对照相比，自主神经病变糖尿病患者的C4水平意外正常。三组糖尿病患者的胰岛素抗体水平无差异。这些发现表明免疫机制可能与糖尿病性自主神经病变的病因有关，需要进一步研究。
