Diabetologia:预测1型糖尿病发展的新方法
2015/03/02
近日,发表在《 Diabetologia》杂志上的一项研究中,科学家们发现通过测定血液中自身抗体(autoantibody)的存在可以检测出免疫系统是否开始破坏自身的胰岛细胞,从而预测1型糖尿病的发展。


近日,发表在《 Diabetologia》杂志上的一项研究中,科学家们发现通过测定血液中自身抗体(autoantibody)的存在可以检测出免疫系统是否开始破坏自身的胰岛细胞,从而预测1型糖尿病的发展。

领导该研究的瑞典隆德大学的Åke Lernmark教授说:“ 在TEDDY的研究中,我们发现自身抗体通常在生命的最初几年中出现。”

TEDDY(The Environmental Determinants of Diabetes in the Young)研究由NIH资助,包括8600名来自瑞典、美国、德国和芬兰的儿童。这些儿童通过出生时脐带血液测试发现他们携带较高的1型糖尿病遗传风险。

抗体是人体免疫系统的一部分,血液中抗体的存在表明免疫系统正在对入侵者,如病毒或细菌作出反应。然而,当免疫系统出现紊乱时也会攻击自身组织、细胞等。自身抗体是自身免疫性疾病的一种标记,表明自身攻击正在进行。

这项研究公布了三种预测1型糖尿病发展的方法:

1, 如果第一次发现的是胰岛素自身抗体(IAA),这通常发生在出生后18月,但这项研究中大多数的受影响的婴儿不到1岁。如果再检测到第二种自身抗体,那么受试者将会患糖尿病,这个过程可能需要20年。

2, 如果第一次发现的是靶向GAD65蛋白的自身抗体(GADA),这通常发生在两岁半,然而这项研究中该现象在2岁时最常见。

3, 如果两种自身抗体在第一次检测时同时发现,在TEDDY研究中,这类小孩有40%已经患上糖尿病。此外,参与研究的小孩中,有6.5%在6岁前产生了第一种自身抗体。

1型糖尿病的遗传风险决定了婴儿会产生哪种自身抗体。然而,免疫系统攻击自身胰岛细胞的原因目前还不清楚,有一种理论认为,病毒感染可能是诱因之一。Åke Lernmark说:“这可能是涉及两种疾病。一种病毒触发了IAA的产生,另一种病毒触发了GADA的产生。”

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  • The 6 year incidence of diabetes-associated autoantibodies in genetically at-risk children: the TEDDY study

    Abstract Aims/hypothesis Islet autoantibodies, in addition to elevated blood glucose, define type 1 diabetes. These autoantibodies are detectable for a variable period of time before diabetes onset. Thus, the occurrence of islet autoantibodies is associated with the beginning of the disease process. The age at, and order in, which autoantibodies appear may be associated with different genetic backgrounds or environmental exposures, or both. Methods Infants with HLA-DR high-risk genotypes (DR3/4, DR4/4, DR4/8 and DR3/3) were enrolled and prospectively followed with standardised autoantibody assessments quarterly throughout the first 4 years of life and then semi-annually thereafter. Results Autoantibodies appeared in 549/8,503 (6.5%) children during 34,091 person-years of follow-up. Autoantibodies at 3 (0.1%) and 6 (0.2%) months of age were rare. Of the 549, 43.7% had islet autoantibodies to insulin (IAA) only, 37.7% had glutamic acid decarboxylase autoantibodies (GADA) only, 13.8% had both GADA and IAA only, 1.6% had insulinoma antigen-2 only and 3.1% had other combinations. The incidence of IAA only peaked within the first year of life and declined over the following 5 years, but GADA only increased until the second year and remained relatively constant. GADA only were more common than IAA only in HLA-DR3/3 children but less common in HLA-DR4/8 children. Conclusions/interpretation Islet autoantibodies can occur very early in life and the order of appearance was related to HLA-DR-DQ genotype.

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