Betterle C, Presotto F, Magrin L, Pedini B, Moro L, Caretto A, Zanchetta R
Istituto di Semeiotica Medica, University of Padua, Italy.
Diabetologia. 1994 Jan;37(1):95-103. doi: 10.1007/BF00428784.
An 11-year prospective study was carried out in 180 non-diabetic patients with organ-specific autoimmune diseases to evaluate islet cell antibodies in predicting Type 1 (insulin-dependent) diabetes mellitus. Islet cell antibodies were characterised according to titres, persistence, complement-fixing ability, and pattern. During follow-up, 14 of 46 patients with islet cell antibodies persistently greater than 5 Juvenile Diabetes Foundation Units (JDF-U) (30.4%), none of 23 with islet cell antibodies between 2.5 and 5 JDF-U or fluctuating, and 3 of 109 without islet cell antibodies (2.7%), developed diabetes. The cumulative risk of developing diabetes was 70%, 0%, and 4%, respectively. All the patients who developed diabetes were females. Eight progressed to insulin-dependence acutely, four showed a transient period of non-insulin-dependence, while two were still insulin-free. No difference was found in titres of islet cell antibodies for the risk of diabetes. Complement-fixing islet cell antibodies enhanced the cumulative risk for the disease in patients with conventional islet cell antibodies at low-middle (> or = 2.5-40 JDF-U), but not at high (> or = 80 JDF-U) titres. Forty-two patients with islet cell antibodies were investigated for the whole or the selective pattern. In the presence of the whole pattern the cumulative risk for diabetes rose to 100%, while with the selective pattern it declined to 34%. The whole pattern was found in 83% of patients who developed Type 1 diabetes acutely. In patients with organ-specific autoimmune diseases, the whole islet cell antibody pattern greatly enhances the prediction for diabetes.
对180例非糖尿病的器官特异性自身免疫性疾病患者进行了一项为期11年的前瞻性研究，以评估胰岛细胞抗体在预测1型（胰岛素依赖型）糖尿病方面的作用。根据滴度、持续性、补体结合能力和模式对胰岛细胞抗体进行了特征分析。在随访期间，46例胰岛细胞抗体持续大于5青少年糖尿病基金会单位（JDF-U）的患者中有14例（30.4%）发生糖尿病，23例胰岛细胞抗体在2.5至5 JDF-U之间或波动的患者中无一例发生糖尿病，109例无胰岛细胞抗体的患者中有3例（2.7%）发生糖尿病。发生糖尿病的累积风险分别为70%、0%和4%。所有发生糖尿病的患者均为女性。8例急性进展为胰岛素依赖型，4例出现非胰岛素依赖的短暂时期，而2例仍无需胰岛素治疗。胰岛细胞抗体滴度与糖尿病风险之间未发现差异。补体结合性胰岛细胞抗体在中低滴度（≥2.5-40 JDF-U）的传统胰岛细胞抗体患者中增加了疾病的累积风险，但在高滴度（≥80 JDF-U）时则没有。对42例有胰岛细胞抗体的患者进行了整体或选择性模式的研究。存在整体模式时糖尿病的累积风险升至100%，而存在选择性模式时则降至34%。83%急性发生1型糖尿病的患者存在整体模式。在器官特异性自身免疫性疾病患者中，整体胰岛细胞抗体模式大大增强了对糖尿病的预测能力。
