Herskowitz-Dumont R, Wolfsdorf J I, Jackson R A, Eisenbarth G S
Joslin Diabetes Center, New England Deaconess Hospital, Boston, Massachusetts.
J Pediatr. 1993 Sep;123(3):347-54. doi: 10.1016/s0022-3476(05)81731-7.
We prospectively studied 63 children with transient hyperglycemia to determine their risk of acquiring insulin-dependent diabetes mellitus (IDDM) and to evaluate the predictive value of immunologic markers of prediabetes and of the intravenous glucose tolerance test. Children with transient hyperglycemia were identified by a prospective systematic review of the laboratory reports of a large children's hospital and an office-based pediatric practice and by referral from pediatricians. Transient hyperglycemia occurred in 0.46% of children seen in the children's hospital and in 0.013% of children attending a pediatric office practice. Insulin-dependent diabetes mellitus developed within 18 months of identification in 32% of children in whom transient hyperglycemia was discovered in the absence of a serious illness, compared with 2.3% of children identified during a serious illness (relative risk, 13.9; 95% confidence interval, 1.56 to 123.5). Islet cell antibodies and competitive insulin autoantibodies each had a 100% positive predictive value for IDDM; the negative predictive value of islet cell antibodies and competitive insulin autoantibodies was 96% and 98%, respectively. The stimulated insulin release during an intravenous glucose tolerance test, adjusted for age, had the highest overall accuracy of prediction. All children less than 6 years of age with stimulated insulin release levels < 85 pmol/L (12 microU/ml) subsequently had IDDM, as did an 11-year-old child whose stimulated insulin release level was below the 1st percentile of 170 pmol/L (24 microU/ml). To date, no child whose stimulated insulin release level was above the 5th percentile has had IDDM. We conclude that when transient hyperglycemia occurs during a serious intercurrent illness, the risk of progression to IDDM is low. In contrast, one third of children in whom transient hyperglycemia is identified without a serious illness can be expected to have IDDM within 1 year. A combination of islet cell antibodies, competitive insulin autoantibodies, and stimulated insulin release levels during an intravenous glucose tolerance test can accurately distinguish children with prediabetes from those with presumed benign transient increases in plasma glucose concentrations.
我们对63例短暂性高血糖患儿进行了前瞻性研究，以确定他们患胰岛素依赖型糖尿病（IDDM）的风险，并评估糖尿病前期免疫标志物及静脉葡萄糖耐量试验的预测价值。通过对一家大型儿童医院和一家儿科门诊实验室报告进行前瞻性系统回顾，并经儿科医生转诊，确定了短暂性高血糖患儿。在儿童医院就诊的患儿中，短暂性高血糖的发生率为0.46%，在儿科门诊就诊的患儿中为0.013%。在无严重疾病情况下发现短暂性高血糖的患儿中，32%在确诊后18个月内发展为胰岛素依赖型糖尿病，而在患有严重疾病时确诊的患儿中这一比例为2.3%（相对风险为13.9；95%置信区间为1.56至123.5）。胰岛细胞抗体和竞争性胰岛素自身抗体对IDDM的阳性预测值均为100%；胰岛细胞抗体和竞争性胰岛素自身抗体的阴性预测值分别为96%和98%。经年龄校正后的静脉葡萄糖耐量试验期间的刺激胰岛素释放具有最高的总体预测准确性。所有6岁以下且刺激胰岛素释放水平<85 pmol/L（12 microU/ml）的患儿随后均发展为IDDM，一名11岁患儿的刺激胰岛素释放水平低于170 pmol/L（24 microU/ml）的第1百分位数，该患儿也发展为IDDM。迄今为止，刺激胰岛素释放水平高于第5百分位数的患儿均未发展为IDDM。我们得出结论，当在严重并发疾病期间发生短暂性高血糖时，进展为IDDM的风险较低。相比之下，在无严重疾病情况下确诊为短暂性高血糖的患儿中，预计有三分之一会在1年内发展为IDDM。胰岛细胞抗体、竞争性胰岛素自身抗体以及静脉葡萄糖耐量试验期间的刺激胰岛素释放水平相结合，能够准确地区分糖尿病前期患儿与血浆葡萄糖浓度假定为良性短暂升高的患儿。
