Rodríguez-Villar C, Conget I, Esmatjes E, Levy I, Calvet J, Figuerola D, Bergua M, Gutiérrez A, Miralles J, Millán M, Peig M, Gomis R
Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona.
Med Clin (Barc). 1996 Sep 28;107(10):371-4.
The aim of this study was to analyze the predictive factors of IDDM in first degree relatives of IDDM patients.
From 1992 to 1994, 1,053 first degree relatives were screened for measuring islet cell antibodies (ICA) by indirect immunofluorescence (iFl). In all ICA positive subjects, beta cell function was analyzed by intravenous glucose tolerance test (IVGTT) and other immunologic parameters were also studied: anti-insulin antibodies (IAA) by radiobinding and antibodies to glutamic acid decarboxylase (GADAb) by ELISA methods.
ICA were found in 3.1% of the first degree relatives. IVGTT showed a significant decrease in acute first phase of insulin response to glucose (IRI 1 minute + 3 minute) in those with ICA > or = 20 JDF units. In patients with ICA > or = 20 JDF units, 20% were found to be positive for IAA and 40% were positive for GAdAb. Thirty-one percent (10/32) of ICA positive first degree relatives fulfilled prediabetes criteria. During follow-up, 40% (4/10) of these prediabetic patients developed IDDM.
This study confirms the possibility of identifying among first degree relatives of IDDM patients the subgroup with high risk of developing IDDM thus allowing the initiation of therapy for preventing or delaying IDDM onset.
本研究旨在分析1型糖尿病（IDDM）患者一级亲属中IDDM的预测因素。
1992年至1994年，对1053名一级亲属进行筛查，采用间接免疫荧光法（iFl）检测胰岛细胞抗体（ICA）。对所有ICA阳性受试者，通过静脉葡萄糖耐量试验（IVGTT）分析β细胞功能，并研究其他免疫参数：采用放射结合法检测抗胰岛素抗体（IAA），采用酶联免疫吸附测定法（ELISA）检测谷氨酸脱羧酶抗体（GADAb）。
在一级亲属中发现3.1%存在ICA。IVGTT显示，ICA≥20 JDF单位的受试者，其对葡萄糖的胰岛素急性第一相反应（IRI 1分钟+3分钟）显著降低。在ICA≥20 JDF单位的患者中，20%的IAA呈阳性，40%的GAdAb呈阳性。31%（10/32）的ICA阳性一级亲属符合糖尿病前期标准。在随访期间，这些糖尿病前期患者中有40%（4/10）发展为IDDM。
本研究证实，在IDDM患者的一级亲属中，有可能识别出具有发展为IDDM高风险的亚组，从而能够启动预防或延迟IDDM发病的治疗。
