婴儿期膳食干预与以后β细胞自身免疫的征象

2010-11-19 MedSci原创 MedSci原创

  背景 在有遗传易感性的儿童中,早期暴露于复合膳食蛋白质类有可能增加β细胞自身免疫和1型糖尿病的危险。我们检验了如下假说:在这种儿童中,用高度水解的配方奶粉补充母乳,将降低糖尿病相关自身抗体的累计发生率。   方法 在这项双盲、随机试验中,我们将230例有HLA赋予的1型糖尿病易感性并且至少1名家庭成员患有1型糖尿病的婴儿进行随机分配,在出生后最初6 ~ 8个月间,每当得不到母乳的时候,即接

  背景 在有遗传易感性的儿童中,早期暴露于复合膳食蛋白质类有可能增加β细胞自身免疫和1型糖尿病的危险。我们检验了如下假说:在这种儿童中,用高度水解的配方奶粉补充母乳,将降低糖尿病相关自身抗体的累计发生率。

  方法 在这项双盲、随机试验中,我们将230例有HLA赋予的1型糖尿病易感性并且至少1名家庭成员患有1型糖尿病的婴儿进行随机分配,在出生后最初6 ~ 8个月间,每当得不到母乳的时候,即接受一种酪蛋白水解配方或一种常规基于牛奶的配方(对照组)。我们在中位数为10年(平均7.5年)的观察期中,采用放射标记分析法分析了胰岛素、谷氨酸脱羧酶(GAD)、胰岛素瘤相关-2分子(IA-2)和锌转运蛋白-8的自身抗体,并且采用免疫荧光法分析了胰岛细胞抗体。儿童在10岁之前一直接受1型糖尿病发病情况的监测。

  结果 与对照组相比,酪蛋白水解物(配方)组1种或1种以上自身抗体阳性的未校正风险比是0.54[95%可信区间(CI)为0.29~0.95],对所观察到的暴露于研究配方持续时间的差异进行校正后的风险比是0.51(95%CI为0.28~0.91)。2种或2种以上自身抗体阳性的未校正风险比是 0.52(95%CI为0.21~1.17),校正后风险比为0.47(95%CI为0.19~1.07)。两组之间报告的不良事件率相似。

  结论 在婴儿期,膳食干预似乎对β细胞自身免疫的标志物(有可能反映导致1型糖尿病的自身免疫过程的指标)有长期影响。

  (N Engl J Med 2010;363:1900-8.November 11,2010)

全文下载:http://www.nejm.org/doi/pdf/10.1056/NEJMoa1004809

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