Akamine H, Komiya I, Shimabukuro T, Asawa T, Tanaka H, Yagi N, Taira T, Nagata K, Arakaki K, Wakugami T, Takasu N, Powell M J, Furmaniak J, Smith B R
Second Department of Internal Medicine, University of the Ryukyus School of Medicine, Okinawa, Japan.
Diabet Med. 1997 Sep;14(9):778-84. doi: 10.1002/(SICI)1096-9136(199709)14:9<778::AID-DIA461>3.0.CO;2-7.
Marked differences have been reported in the prevalence of glutamic acid decarboxylase (GAD) antibodies between Caucasian (63-84%) and Japanese (30-50%) or Asian (5-50%) IDDM patients. Using a new immunoprecipitation assay based on 125I-labelled recombinant human GAD65 we have reassessed prevalence of GAD65 antibodies in Japanese patients. We also assessed prevalence of IA-2 antibodies. GAD65 antibodies were detected in 83.3% of sera taken within 1 year of onset, comparable to the prevalence reported in Caucasian patients. Positivity decreased to 66.7% after 2 to 3 years and to 54.3% after 3 years from onset, still higher than previously reported Asian prevalence. Except in one patient, high antibody levels persisted chronically, up to 12 years. There was no difference in the prevalence of GAD65 antibodies between Japanese IDDM patients with and without autoimmune thyroid disease (AITD). IA-2 antibodies were detected in 64.7% of sera taken within 1 year of onset. Prevalence of IA-2 antibodies was lower than that of GAD65 antibodies. The difference in positivity in Asian IDDM patients between present and previous reports arose from the sensitivity of our assay for GAD65 antibodies. Additionally, the patients we studied had classic IDDM with a well-defined onset. We conclude that prevalence of GAD65 antibodies in Japanese IDDM patients is comparable to that in Western studies. There was no relationship of GAD65 antibody positivity to coexistence of AITD. Our results suggest that autoimmunity is the most significant cause of Japanese IDDM.
据报道，白种人（63%-84%）与日本（30%-50%）或亚洲（5%-50%）的胰岛素依赖型糖尿病（IDDM）患者中，谷氨酸脱羧酶（GAD）抗体的患病率存在显著差异。我们使用基于125I标记的重组人GAD65的新型免疫沉淀试验，重新评估了日本患者中GAD65抗体的患病率。我们还评估了IA-2抗体的患病率。在发病1年内采集的血清中，83.3%检测到GAD65抗体，这一患病率与白种人患者中报道的患病率相当。发病2至3年后，阳性率降至66.7%，发病3年后降至54.3%，仍高于先前报道的亚洲患病率。除1例患者外，高抗体水平长期持续存在，长达12年。有无自身免疫性甲状腺疾病（AITD）的日本IDDM患者中，GAD65抗体的患病率没有差异。在发病1年内采集的血清中，64.7%检测到IA-2抗体。IA-2抗体的患病率低于GAD65抗体。目前与先前报道的亚洲IDDM患者阳性率差异源于我们的GAD65抗体检测方法的敏感性。此外，我们研究的患者患有典型的IDDM，发病明确。我们得出结论，日本IDDM患者中GAD65抗体的患病率与西方研究中的患病率相当。GAD65抗体阳性与AITD的共存没有关系。我们的结果表明，自身免疫是日本IDDM最主要的病因。
