Andréoletti L, Hober D, Hober-Vandenberghe C, Fajardy I, Belaich S, Lambert V, Vantyghem M C, Lefebvre J, Wattre P
Laboratoire de Virologie, Institut Gernez Rieux, Bâtiment IRFPPS, Centre Hospitalier Régional et Universitaire, Lille, France.
Clin Diagn Virol. 1998 Apr;9(2-3):125-33. doi: 10.1016/s0928-0197(98)00011-7.
Environmental agents such as viruses have been identified as potentially important determinants of insulin-dependent diabetes mellitus (IDDM). Enterovirus infections, Coxsackievirus B especially, could be linked to the beta cell damaging process and to the onset of clinical IDDM.
Enteroviral (EV) infection and beta cell autoimmunity were studied in adult patients at the onset of IDDM.
A total of 14 newly diagnosed-IDDM patients with ketosis or ketoacidosis were compared to, anteriorly diagnosed IDDM patients with metabolic decompensation, non-IDDM patients with metabolic decompensation and healthy adults. EV infection was studied by genomic RNA detection in whole blood using a RT-PCR assay. In order to assess the level of beta cell autoantibodies at the time of the initial metabolic decompensation, serum specimens from IDDM patients were tested for GAD65 antibodies and islet cell antibodies (ICAs).
Coxsackie B3 or B4 virus genome was detected and genotyped in five of 14 (35.7) newly diagnosed IDDM patients and in one of 12 (8%) patients in the course of IDDM. By contrast, none of the 12 non-IDDM patients and none of the 15 healthy adults was positive for enterovirus RNA detection in whole blood. Positive GAD65 antibodies and ICAs assays were not significantly correlated to a positive EV-RNA detection.
The present study demonstrates that Coxsackie B virus RNA sequences can be detected in the peripheral blood from adult patients at the onset or in the course of IDDM and suggests that a Coxsackie B virus infection could initiate or accelerate beta cell autoimmune damaging process.
病毒等环境因素已被确认为胰岛素依赖型糖尿病（IDDM）的潜在重要决定因素。肠道病毒感染，尤其是柯萨奇B组病毒，可能与β细胞损伤过程及临床IDDM的发病有关。
研究IDDM发病时成年患者的肠道病毒（EV）感染及β细胞自身免疫情况。
将14例新诊断为IDDM且伴有酮症或酮症酸中毒的患者与先前诊断为IDDM且伴有代谢失代偿的患者、伴有代谢失代偿的非IDDM患者及健康成年人进行比较。采用逆转录聚合酶链反应（RT-PCR）法通过检测全血中的基因组RNA来研究EV感染。为了评估初始代谢失代偿时β细胞自身抗体的水平，对IDDM患者的血清标本进行了谷氨酸脱羧酶65（GAD65）抗体和胰岛细胞抗体（ICA）检测。
在14例新诊断的IDDM患者中有5例（35.7%）检测到柯萨奇B3或B4病毒基因组并进行了基因分型，在IDDM病程中的12例患者中有1例（8%）检测到。相比之下，12例非IDDM患者和15例健康成年人中全血肠道病毒RNA检测均为阴性。GAD65抗体和ICA检测阳性与EV-RNA检测阳性无显著相关性。
本研究表明，在IDDM发病时或病程中成年患者的外周血中可检测到柯萨奇B组病毒RNA序列，提示柯萨奇B组病毒感染可能启动或加速β细胞自身免疫损伤过程。
