Colman P G, McNair P, Margetts H, Schmidli R S, Werther G A, Alford F P, Ward G M, Tait B D, Honeyman M C, Harrison L C
Department of Diabetes and Endocrinology, Walter and Eliza Hall Institute of Medical Research, Royal Melbourne Hospital, VIC.
Med J Aust. 1998 Jul 20;169(2):81-4. doi: 10.5694/j.1326-5377.1998.tb140188.x.
To determine the utility of various autoantibodies in predicting progression to clinical diabetes in first-degree relatives of patients with type 1 diabetes mellitus.
3315 first-degree relatives of patients with type 1 diabetes (1161 parents, 1206 siblings and 948 offspring) recruited through diabetes clinics, private endocrinologists, Diabetes Australia and the Juvenile Diabetes Foundation.
Prevalence of islet cell antibodies (ICA) levels > or = 20 JDFu, insulin autoantibodies (IAA) levels > 100 nU/mL, and antibodies to glutamic acid decarboxylase (GADAb) and tyrosine phosphatase IA2 (IA2Ab); change in beta cell function over time; and development of clinical diabetes.
2.6% of relatives had elevated ICA levels, 1.3% had elevated IAA levels and 0.3% had both. High ICA levels were significantly more frequent in siblings than in offspring or parents, and were more frequent in relatives younger than 20 years. GADAb were detected in 68% and IA2Ab in 57% of relatives with elevated ICA and/or IAA levels. Diabetes developed in 33 relatives (25 siblings, 2 offspring and 6 parents). Before diagnosis of clinical diabetes, high ICA levels were detected in 18 (58%), high IAA levels in 7 (23%), both in 5 (15%), and either in 19 (61%); GADAb were detected in 26 (84%), IA2Ab in 13 (42%), both in 11 (35%), and either in 28 (90%). First phase insulin release (FPIR) less than 50 mU/L was very strongly associated with progression to diabetes. In relatives with FPIR initially greater than 50 mU/L who eventually developed diabetes, there was a gradual and continuous reduction in FPIR over time before diagnosis.
Type 1 diabetes can be diagnosed in the preclinical stage. The recently described antibodies to glutamic acid decarboxylase and tyrosine phosphatase IA2 appear superior to ICA as screening tools for the preclinical diagnosis of type 1 diabetes.
确定各种自身抗体在预测1型糖尿病患者一级亲属进展为临床糖尿病方面的效用。
通过糖尿病诊所、私人内分泌科医生、澳大利亚糖尿病协会和青少年糖尿病基金会招募的3315名1型糖尿病患者的一级亲属（1161名父母、1206名兄弟姐妹和948名子女）。
胰岛细胞抗体（ICA）水平≥20 JDFu、胰岛素自身抗体（IAA）水平>100 nU/mL、谷氨酸脱羧酶抗体（GADAb）和酪氨酸磷酸酶IA2抗体（IA2Ab）的患病率；β细胞功能随时间的变化；以及临床糖尿病的发生。
2.6%的亲属ICA水平升高，1.3%的亲属IAA水平升高，0.3%的亲属两者均升高。ICA水平高在兄弟姐妹中比在子女或父母中更常见，在20岁以下的亲属中更常见。在ICA和/或IAA水平升高的亲属中，68%检测到GADAb，57%检测到IA2Ab。33名亲属（25名兄弟姐妹、2名子女和6名父母）患糖尿病。在临床糖尿病诊断前，18名（58%）检测到ICA水平高，7名（23%）检测到IAA水平高，5名（15%）两者均高，19名（61%）检测到其中之一；26名（84%）检测到GADAb，13名（42%）检测到IA2Ab，11名（35%）两者均检测到，28名（90%）检测到其中之一。第一相胰岛素释放（FPIR）低于50 mU/L与进展为糖尿病密切相关。在最初FPIR大于50 mU/L最终患糖尿病的亲属中，诊断前FPIR随时间逐渐持续下降。
1型糖尿病可在临床前期被诊断。最近描述的谷氨酸脱羧酶抗体和酪氨酸磷酸酶IA2抗体作为1型糖尿病临床前期诊断的筛查工具似乎优于ICA。
