Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
Pediatr Diabetes. 2018 Nov;19(7):1221-1228. doi: 10.1111/pedi.12697. Epub 2018 Jun 17.
The present study tested the hypothesis that girls have a more aggressive disease process than boys at the diagnosis of type 1 diabetes (T1D).
Demographic and clinical characteristics, the humoral autoantibody profile, and the genetic risk assessed by the presence of human leukocyte antigen DR-DQ haplotypes were analyzed in terms of sex in 4993 children and adolescents diagnosed with T1D between January 2003 and December 2016.
A clear male preponderance (56.6%) was observed in our cohort and boys were significantly older than girls at clinical diagnosis (mean 8.3 vs 7.7 years, P < .001). Age-adjusted analyses showed a poorer metabolic decompensation in girls than boys at diagnosis. Boys tested more often positive for autoantibodies against insulin autoantibodies (P = .008), islet antigen-2 autoantibodies (P = .033), and zinc transporter 8 autoantibodies (P = .027), whereas girls had a higher frequency of glutamic acid decarboxylase autoantibodies (GADA) (P < .001) and higher GADA (P < .001) and islet cell antibody titers (P = .001). We did not find any significant differences in the genetic risk profile between girls and boys.
Our data show that the metabolic derangement is more severe in girls already at diagnosis of T1D and this finding is independent of age. The immunologic aggressiveness of the disease is more variable as the predominance of different autoantibodies varies between sexes with a higher frequency of GADA in girls, while the 3 other biochemical autoantibodies were more common in boys.
本研究旨在检验以下假设，即在诊断 1 型糖尿病（T1D）时，女孩的疾病进程比男孩更具攻击性。
分析了 2003 年 1 月至 2016 年 12 月期间 4993 名确诊为 T1D 的儿童和青少年的人口统计学和临床特征、体液自身抗体谱以及通过人类白细胞抗原 DR-DQ 单倍型评估的遗传风险，并根据性别进行了分析。
在我们的队列中观察到明显的男性优势（56.6%），且男孩在临床诊断时明显比女孩年龄大（平均 8.3 岁 vs 7.7 岁，P<.001）。年龄调整分析显示，女孩在诊断时代谢失代偿的情况较男孩差。与男孩相比，女孩的胰岛素自身抗体（P=0.008）、胰岛抗原-2 自身抗体（P=0.033）和锌转运体 8 自身抗体（P=0.027）检测呈阳性的频率更高，而谷氨酸脱羧酶自身抗体（GADA）（P<.001）和 GADA（P<.001）和胰岛细胞抗体滴度（P=0.001）更高。我们没有发现女孩和男孩之间的遗传风险谱有任何显著差异。
我们的数据表明，T1D 女孩在诊断时的代谢紊乱更为严重，这一发现与年龄无关。疾病的免疫侵袭性更为多变，因为不同自身抗体在性别之间的优势不同，GADA 在女孩中更为常见，而另外 3 种生化自身抗体在男孩中更为常见。
