Pastore M R, Bazzigaluppi E, Bonfanti R, Dozio N, Sergi A, Balini A, Belloni C, Meschi F, Bonifacio E, Bosi E
Department of Internal Medicine, Istituto Scientifico Ospedale San Raffaele, University of Milan, Italy.
Diabetes Care. 1998 Sep;21(9):1445-50. doi: 10.2337/diacare.21.9.1445.
To examine the performance of islet cell antibodies (ICAs) and antibodies to glutamate decarboxylase (GADA), IA-2 (IA-2 antibody [IA-2A]), and insulin (insulin autoantibody [IAA]), alone and in combination, in assessing type 1 diabetes risk within type 1 diabetic families to identify a practical and effective screening strategy for predicting type 1 diabetes in relatives.
ICA, GADA, IA-2A, and IAA were determined in 806 first-degree relatives participating in a prospective type 1 diabetes family study (median follow-up 6.17 years, range 0.6-8.3). The conferred risk of developing type 1 diabetes within 6 years was evaluated by Kaplan-Meier for each antibody marker, used alone or in combination.
ICAs were detected in 3%, GADA in 5.1%, IA-2A in 2.5%, and IAA in 3.7% of relatives; > or =1 antibody markers were detected in 10.7% of relatives and > or =2 were detected in 1.9% of relatives. The risk of type 1 diabetes at 6 years was 1.5% in relatives with only 1 marker and 24.8% in relatives with > or =2 markers. As a practical and effective strategy for type 1 diabetes risk assessment in relatives, this study indicates a first-step screening based on GADA and IA-2A measurement--which identified 6.5% of relatives, including all who developed the disease, with a 6-year type 1 diabetes risk of 9.0%--followed by a second step based on ICA and IAA measurement in relatives with either GADA or IA-2A, which identified a total of 1.9% of all relatives as having > or =2 markers, and a 6-year risk of 24.8%, including 6 of 7 who developed type 1 diabetes.
A two-step antibody screening, based first on GADA and IA-2A and then on ICA and IAA measurements in identified individuals, is likely to be a practical, sensitive, and effective strategy for predicting type 1 diabetes in first-degree relatives.
研究胰岛细胞抗体（ICA）、谷氨酸脱羧酶抗体（GADA）、IA-2抗体（IA-2A）和胰岛素自身抗体（IAA）单独及联合检测在评估1型糖尿病家族中1型糖尿病发病风险方面的表现，以确定一种实用且有效的亲属1型糖尿病预测筛查策略。
对参与一项前瞻性1型糖尿病家族研究的806名一级亲属进行ICA、GADA、IA-2A和IAA检测（中位随访时间6.17年，范围0.6 - 8.3年）。采用Kaplan-Meier法评估每种抗体标志物单独或联合使用时在6年内发生1型糖尿病的风险。
亲属中ICA检测阳性率为3%，GADA为5.1%，IA-2A为2.5%，IAA为3.7%；10.7%的亲属检测到≥1种抗体标志物，1.9%的亲属检测到≥2种抗体标志物。仅有一种标志物的亲属6年时患1型糖尿病的风险为1.5%，有≥2种标志物的亲属为24.8%。作为亲属1型糖尿病风险评估的实用有效策略，本研究表明第一步基于GADA和IA-2A检测进行筛查（该筛查识别出6.5%的亲属，包括所有发病者，6年1型糖尿病风险为9.0%），第二步对检测出GADA或IA-2A的亲属进行ICA和IAA检测，该步骤共识别出1.9%的亲属有≥2种标志物，6年风险为24.8%，其中7名患1型糖尿病者中有6名在此组。
基于GADA和IA-2A检测，然后对检测出的个体进行ICA和IAA检测的两步抗体筛查法，可能是预测一级亲属1型糖尿病的实用、敏感且有效的策略。
