Denina Marco, Trada Michela, Tinti Davide, Funiciello Elisa, Novara Chiara, Moretto Martina, Rosati Sergio, Garazzino Silvia, Bondone Claudia, De Sanctis Luisa
Department of Pediatric Emergency, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
Infectious Diseases Unit, Department of Pediatrics, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
Front Med (Lausanne). 2022 Jul 28;9:927099. doi: 10.3389/fmed.2022.927099. eCollection 2022.
Several studies have investigated the correlation between the COVID-19 pandemic and the onset of type 1 diabetes (T1D) in children, reporting an increased incidence of T1D and severe diabetic ketoacidosis (DKA). This study aimed to investigate the infection by SARS-CoV-2 in children with newly-diagnosed T1D to explore a possible link between SARS-CoV-2 infection, T1D and DKA. Thirty-nine children with a T1D new onset between October 15, 2020, and April 15, 2021, were enrolled. SARS-CoV-2 infection was investigated through a polymerase chain reaction on the nasal swab, dosage of specific antibodies, and an anamnestic question form. Nine (23%) of them had antibodies directed toward SARS-CoV-2, and five (12%) had a history of recent SARS-CoV-2 infection in themselves or in their family. No molecular swabs were positive. Compared to the general pediatric population, the overall incidence of COVID-19 was 5.6 times higher in the T1D patients' group ( < 0.00001). Referring only to the cases in the metropolitan area, we find a net increase in the incidence of T1D compared to the 5 years preceding our study, by 50% compared to the same months in 2016/2017 and 2017/2018, by 69% compared to 2018/2019 and by 77% compared to 2019/2020. The same trend was observed regarding DKA cases. The attributable risk of the pandemic cohort compared to the previous year is 44%. The abnormal disproportion of SARS-CoV-2 infection between children with T1D and the pediatric reference population, with a ratio of 5.6, appears to support the causative role of SARS-CoV-2 in triggering the immune response underlying diabetes, as often described for other viral infections. The difficulty accessing care services during the pandemic, with a consequent diagnosis delay, does not justify the increase in observed T1D cases, which could to be directly linked to the pandemic. The acceleration of the immune process provoked by SARS-CoV-2 may play a suggestive role in the development of T1D with DKA. Multicenter studies are needed to deepen and fully understand the pathophysiological link between SARS-CoV-2 and the onset of T1D in children.
多项研究调查了新冠疫情与儿童1型糖尿病（T1D）发病之间的相关性，报告称T1D及严重糖尿病酮症酸中毒（DKA）的发病率有所上升。本研究旨在调查新诊断的T1D患儿中SARS-CoV-2的感染情况，以探索SARS-CoV-2感染、T1D和DKA之间可能存在的联系。研究纳入了2020年10月15日至2021年4月15日期间新发病的39例T1D患儿。通过对鼻咽拭子进行聚合酶链反应、检测特异性抗体以及采用问诊问卷的方式来调查SARS-CoV-2感染情况。其中9例（23%）患儿体内有针对SARS-CoV-2的抗体，5例（12%）患儿自身或其家人有近期SARS-CoV-2感染史。鼻咽拭子的分子检测结果均为阴性。与普通儿科人群相比，T1D患者组中新冠病毒感染的总体发病率高出5.6倍（<0.00001）。仅参考大都市地区的病例，我们发现与本研究前5年相比，T1D发病率有净增长，与2016/2017年和2017/2018年同期相比增长了50%，与2018/2019年相比增长了69%，与2019/2020年相比增长了77%。DKA病例也呈现出相同的趋势。与上一年相比，疫情队列的归因风险为44%。T1D患儿与儿科参考人群之间SARS-CoV-2感染的异常不均衡比例为5.6，这似乎支持了SARS-CoV-2在引发糖尿病潜在免疫反应中所起的致病作用，正如其他病毒感染常被描述的那样。疫情期间获得医疗服务困难，进而导致诊断延迟，这并不能解释所观察到的T1D病例增加的情况，这些病例可能与疫情直接相关。SARS-CoV-2引发的免疫过程加速可能在伴有DKA的T1D发展中起提示作用。需要开展多中心研究来深入并全面了解SARS-CoV-2与儿童T1D发病之间的病理生理联系。
