Vita-Salute San Raffaele University, Milan, Italy.
Diabetes Research Institute, IRCCS San Raffaele Hospital, Milano, Italy.
BMJ Open Diabetes Res Care. 2021 Feb;9(1). doi: 10.1136/bmjdrc-2019-001158.
Aim of this study was to investigate the pancreatic exocrine function in patients with type 1 diabetes (T1D) by multiple non-invasive tests.
The study is a single-center, cross-sectional study of pancreatic exocrine function in adult patients with new-onset or long-standing T1D and healthy controls.
Healthy controls, new-onset T1D, and long-standing T1D were similar for age at the time of the study, gender and body mass index (BMI) categories. Age of onset of T1D patients with long-standing disease was younger than that of patients with new-onset T1D (p<0.001). As expected, the three groups differed for C-peptide and hemoglobin A1c (HbA1c) levels. Lipase activity measured by C-mixed triglyceride breath test was reduced progressively, although not significantly, from controls to recent-onset T1D and long-standing T1D participants. Fecal elastase-1 was significantly lower in participants with T1D, either new onset or long standing. Pancreatic amylase, lipase, retinol binding protein and prealbumin were significantly different across the groups, with a significant trend toward lower values in long-standing T1D and intermediate values in new-onset T1D, while no differences were observed for total amylase. The markers of impaired exocrine function tests (fecal elastase-1, serum pancreatic amylase and lipase) and of nutritional status (retinol binding protein and prealbumin levels) correlated with the reduction of fasting and urinary C-peptide.
Our results confirm that exocrine pancreatic impairment is a feature of T1D, with low fecal elastase-1, serum pancreatic amylase and lipase as specific markers, associated with reduced levels of nutritional indexes. Moreover, the evidence of more advanced insufficiency in long-standing disease reflects the chronic nature of this process, and its correlation with the residual β-cell function suggests parallel pathways for the impairment of the endocrine and exocrine pancreatic function.
本研究旨在通过多种非侵入性检测方法来研究 1 型糖尿病（T1D）患者的胰腺外分泌功能。
本研究为单中心、横断面研究，纳入新诊断或长期 T1D 成年患者及健康对照者。
健康对照组、新诊断 T1D 组和长期 T1D 组在研究时的年龄、性别和体重指数（BMI）类别上无差异。长期 T1D 患者的发病年龄小于新诊断 T1D 患者（p<0.001）。正如预期的那样，三组在 C 肽和糖化血红蛋白（HbA1c）水平上存在差异。通过 C-混合三酰甘油呼吸试验测量的脂肪酶活性逐渐降低，尽管无统计学意义，但从对照组到新诊断 T1D 组和长期 T1D 组均降低。新诊断 T1D 和长期 T1D 患者的粪便弹性蛋白酶-1 均显著降低。胰淀粉酶、脂肪酶、视黄醇结合蛋白和前白蛋白在各组间存在显著差异，长期 T1D 组值较低，新诊断 T1D 组值居中，而总淀粉酶无差异。外分泌功能试验（粪便弹性蛋白酶-1、血清胰淀粉酶和脂肪酶）和营养状态（视黄醇结合蛋白和前白蛋白水平）的受损标志物与空腹和尿 C 肽降低相关。
我们的结果证实，胰腺外分泌功能受损是 T1D 的特征，粪便弹性蛋白酶-1、血清胰淀粉酶和脂肪酶降低是特异性标志物，与营养指标水平降低相关。此外，长期 T1D 中更严重的不足证据反映了这一过程的慢性性质，其与残余β细胞功能的相关性提示内分泌和外分泌胰腺功能损害的平行途径。
