JAMA: 胰岛自身抗体筛查助力儿童T1DM风险识别

2020-02-14 国际糖尿病 idiabetes

目前尚缺乏有效措施促使T1DM患者的胰岛素不足及代谢稳定性得以恢复,故T1DM患者常需要终生接受胰岛素治疗,因此,T1DM的早期识别和预防尤为重要。既往研究显示T1DM在无症状期仅存在胰岛β细胞自身抗体而无高血糖,那么,通过胰岛β细胞自身抗体筛查是否可以将T1DM识别再度提前?根据JAMA发表的一项最新研究结果,T1DM无症状期增加了2~5岁儿童罹患临床T1DM的风险,胰岛自身抗体筛查可早期识别这

目前尚缺乏有效措施促使T1DM患者的胰岛素不足及代谢稳定性得以恢复,故T1DM患者常需要终生接受胰岛素治疗,因此,T1DM的早期识别和预防尤为重要。既往研究显示T1DM在无症状期仅存在胰岛β细胞自身抗体而无高血糖,那么,通过胰岛β细胞自身抗体筛查是否可以将T1DM识别再度提前?根据JAMA发表的一项最新研究结果,T1DM无症状期增加了2~5岁儿童罹患临床T1DM的风险,胰岛自身抗体筛查可早期识别这种风险。



这项队列研究纳入了德国巴伐利亚州90632例1.75-5.99岁儿童(中位年龄3.1岁,48.5%女孩),进行胰岛自身抗体筛查。T1DM无症状期的诊断标准为存在2种及以上胰岛自身抗体。T1DM分为3期:1期:胰岛自身抗体阳性数量≥2,但血糖正常;2期:胰岛自身抗体阳性数量≥2,伴有糖耐量异常或血糖异常;3期:FPG≥7mmol/L或PPG≥11.11mmol/L或HbA1c>6.5%,或伴有高血糖的典型临床症状与体征。随访2.4年(中位)间,研究者评估了所有受试者临床T1DM和糖尿病酮症酸中毒(DKA)的发病率。此外,受试者父母在基线、随访6个月和12个月时填写了PHQ-9抑郁症筛查量表,以评估心理压力。

结果显示,280例受试者为T1DM无症状期,其中,196例为T1DM-1期,17例为T1DM-2期,26例为T1DM-3期,41例未分期。随访结束后,36例受试者发展为T1DM-3期,2例受试者出现DKA。无症状T1DM受试者发展为T1DM-3期的3年累积风险为24.9%(95%CI:18.5%~30.7%,年化风险为9%)。T1DM-1期受试者发展为T1DM-2/3期的3年累积风险为28.7%(95%CI:21%~35.6%,年化风险为10.6%)。值得注意的是,4例在基线检查时不满足无症状T1DM标准的受试者发展为临床T1DM。

T1DM无症状期受试者的母亲PHQ-9抑郁症筛查量表得分显著高于正常受试者母亲(3 vs. 2分,P=0.002),随着时间的推移,T1DM无症状期受试者的母亲PHQ-9抑郁症筛查量表得分明显下降(P<0.01)。

德国纽赫堡慕尼黑赫尔姆霍兹中心糖尿病研究所Anette Gabriele Ziegler博士表示,“尽管我们想降低DKA的发生率,但真正的目标是预防临床T1DM。尽管胰岛素抗体筛查仅限于有T1DM家族史的儿童,其结果也已经显示胰岛自身抗体筛查是有效的,可以显著减少T1DM急性发病。这意味着我们可以扩大人群、缩短筛查时间,从而让更多的儿童在更短的时间内从胰岛自身抗体筛查中获益。”

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    2020-06-22 baoya
  2. [GetPortalCommentsPageByObjectIdResponse(id=1750132, encodeId=a7d61e5013206, content=<a href='/topic/show?id=be7c8385345' target=_blank style='color:#2F92EE;'>#胰岛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83853, encryptionId=be7c8385345, topicName=胰岛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7a536274692, createdName=baoya, createdTime=Mon Jun 22 21:21:00 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393675, encodeId=de2013936e534, content=<a href='/topic/show?id=81721e04061' target=_blank style='color:#2F92EE;'>#T1DM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17040, encryptionId=81721e04061, topicName=T1DM)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLx96cCLjNYsHar1XErTVibOydfEC9iaYgrXp3SicXwntSAEDeQAlM2vLqTfm6oPORxaib3UIgyHQJJ7A/132, createdBy=36f02500138, createdName=ms6980045490879608, createdTime=Sun Feb 16 12:21:00 CST 2020, time=2020-02-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1519110, encodeId=2d411519110fb, content=<a href='/topic/show?id=8a8d1e03926' target=_blank style='color:#2F92EE;'>#T1D#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17039, encryptionId=8a8d1e03926, topicName=T1D)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=677711243794, createdName=huhuaidong391, createdTime=Sun Feb 16 12:21:00 CST 2020, time=2020-02-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035911, encodeId=bb391035911cd, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Feb 15 00:21:00 CST 2020, time=2020-02-15, status=1, ipAttribution=)]
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    2020-02-16 huhuaidong391
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    2020-02-15 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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