Xu Zhen-Ran, Xi Li, Wu Jing, Ni Jin-Wen, Luo Fei-Hong, Zhang Miao-Ying
Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai 201102, China.
World J Diabetes. 2024 Dec 15;15(12):2276-2284. doi: 10.4239/wjd.v15.i12.2276.
The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increased incidence of diabetes and diabetic ketoacidosis (DKA). However, the relationship between COVID-19 infection and progression to type 1 diabetes (T1D) in children has not been well defined.
To evaluate the influence of COVID-19 infection and inactivated vaccine administration on the progression of T1D among Chinese children.
A total of 197 newly diagnosed patients with T1D were retrospectively enrolled from Children's Hospital of Fudan University between September 2020 and December 2023. The patients were divided into three groups based on their history of COVID-19 infection and vaccination: the infection group, the vaccination-only group, and the non-infection/non-vaccination group. Comprehensive clinical assessments and detailed immunological evaluations were performed to delineate the characteristics and immune responses of these groups.
The incidence of DKA was significantly higher in the COVID-19 infection group (70.2%) compared to the non-infection/non-vaccination group (62.5%) and vacscination-only group (45.6%; = 0.015). Prior COVID-19 infection was correlated with increased DKA risk (OR: 1.981, 95%CI: 1.026-3.825, = 0.042), while vaccination was associated with a reduced risk (OR: 0.558, 95%CI: 0.312-0.998, = 0.049). COVID-19 infection mildly altered immune profiles, with modest differences in autoantibody positivity, lymphocyte distribution, and immunoglobulin levels. Notably, positive children with a history of COVID-19 infection had an earlier T1D onset and lower fasting C-peptide levels than the negative children with a history of infection (both < 0.05).
COVID-19 infection predisposes children to severe T1D, characterized by enhanced DKA risk. Inactivated vaccination significantly lowers DKA incidence at T1D onset. These findings are valuable for guiding future vaccination and T1D risk surveillance strategies in epidemic scenarios in the general pediatric population.
2019年冠状病毒病（COVID-19）大流行与糖尿病和糖尿病酮症酸中毒（DKA）发病率增加有关。然而，COVID-19感染与儿童1型糖尿病（T1D）进展之间的关系尚未明确。
评估COVID-19感染和灭活疫苗接种对中国儿童T1D进展的影响。
2020年9月至2023年12月，从复旦大学附属儿科医院回顾性纳入197例新诊断的T1D患者。根据COVID-19感染和疫苗接种史将患者分为三组：感染组、仅接种疫苗组和未感染/未接种疫苗组。进行了全面的临床评估和详细的免疫学评估，以描述这些组的特征和免疫反应。
COVID-19感染组的DKA发病率（70.2%）显著高于未感染/未接种疫苗组（62.5%）和仅接种疫苗组（45.6%；P = 0.015）。既往COVID-19感染与DKA风险增加相关（OR：1.981，95%CI：1.026 - 3.825，P = 0.042），而接种疫苗与风险降低相关（OR：0.558，95%CI：0.312 - 0.998，P = 0.049）。COVID-19感染轻微改变了免疫谱，自身抗体阳性、淋巴细胞分布和免疫球蛋白水平存在适度差异。值得注意的是，有COVID-19感染史的阳性儿童比有感染史的阴性儿童T1D发病更早且空腹C肽水平更低（均P < 0.05）。
COVID-19感染使儿童易患严重T1D，其特征为DKA风险增加。灭活疫苗接种显著降低T1D发病时的DKA发病率。这些发现对于指导普通儿科人群在流行情况下的未来疫苗接种和T1D风险监测策略具有重要价值。
