Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
Department of Diabetes and Endocrinology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
Pediatr Diabetes. 2020 Sep;21(6):945-949. doi: 10.1111/pedi.13056. Epub 2020 Jun 9.
We aimed to monitor pancreatic exocrine function longitudinally in relation to the development of islet autoimmunity (IA) and type 1 diabetes (T1D) in at-risk children with a first-degree relative with T1D, who were followed prospectively in the Environmental Determinants of Islet Autoimmunity (ENDIA) study.
Fecal elastase-1 (FE-1) concentration was measured longitudinally in 85 ENDIA children from median age 1.0 (IQR 0.7,1.3) year. Twenty-eight of 85 children (progressors) developed persistent islet autoantibodies at median age of 1.5 (IQR 1.1,2.5) years, of whom 11 went on to develop clinical diabetes. The other 57 islet autoantibody-negative children (non-progressors) followed similarly were age and gender-matched with the progressors. An adjusted linear mixed model compared FE-1 concentrations in progressors and non-progressors.
Baseline FE-1 did not differ between progressors and non-progressors, or by HLA DR type or proband status. FE-1 decreased over time in progressors in comparison to non-progressors (Wald statistic 5.46, P = .02); in some progressors the fall in FE-1 preceded the onset of IA.
Pancreatic exocrine function decreases in the majority of young at-risk children who progress to IA and T1D.
我们旨在监测与 1 型糖尿病（T1D）相关的胰岛自身免疫（IA）和 T1D 的发展，对一级亲属中有 T1D 的高危儿童进行前瞻性研究，监测环境决定胰岛自身免疫（ENDIA）研究中的胰腺外分泌功能。
在 ENDIA 研究中，对 85 名中位年龄为 1.0（IQR 0.7，1.3）岁的儿童进行了粪便弹性蛋白酶-1（FE-1）浓度的纵向测量。28 名 85 名儿童（进展者）在中位年龄 1.5（IQR 1.1，2.5）岁时出现持续的胰岛自身抗体，其中 11 名进展为临床糖尿病。其余 57 名胰岛自身抗体阴性的儿童（非进展者）同样随访，与进展者年龄和性别匹配。调整后的线性混合模型比较了进展者和非进展者的 FE-1 浓度。
进展者和非进展者之间，或与 HLA DR 类型或先证者状态之间，基线 FE-1 无差异。与非进展者相比，进展者的 FE-1 随时间推移而下降（Wald 统计量为 5.46，P=0.02）；在一些进展者中，FE-1 的下降先于 IA 的发生。
在大多数进展为 IA 和 T1D 的高危儿童中，胰腺外分泌功能下降。
