A novel subtype of type 1 diabetes mellitus characterized by a rapid onset and an absence of diabetes-related antibodies.

被引:473
作者
Imagawa, A [1 ]
Hanafusa, T [1 ]
Miyagawa, J [1 ]
Matsuzawa, Y [1 ]
机构
[1] Osaka Univ, Grad Sch Med, Dept Internal Med & Mol Sci, Suita, Osaka 5650871, Japan
关键词
D O I
10.1056/NEJM200002033420501
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background and Methods: Type 1 diabetes mellitus is now classified as autoimmune (type 1A) or idiopathic (type 1B), but little is known about the latter. We classified 56 consecutive Japanese adults with type 1 diabetes according to the presence or absence of glutamic acid decarboxylase antibodies (their presence is a marker of autoimmunity) and compared their clinical, serologic, and pathological characteristics. Results: We divided the patients into three groups: 36 patients with positive tests for serum glutamic acid decarboxylase antibodies, 9 with negative tests for serum glutamic acid decarboxylase antibodies and glycosylated hemoglobin values higher than 11.5 percent, and 11 with negative tests for serum glutamic acid decarboxylase antibodies and glycosylated hemoglobin values lower than 8.5 percent. In comparison with the first two groups, the third group had a shorter mean duration of symptoms of hyperglycemia (4.0 days), a higher mean plasma glucose concentration (773 mg per deciliter [43 mmol per liter]) in spite of lower glycosylated hemoglobin values, diminished urinary excretion of C peptide, a more severe metabolic disorder (with ketoacidosis), higher serum pancreatic enzyme concentrations, and an absence of islet-cell, IA-2, and insulin antibodies. Immunohistologic studies of pancreatic-biopsy specimens from three patients with negative tests for glutamic acid decarboxylase antibodies and low glycosylated hemoglobin values revealed T-lymphocyte-predominant infiltrates in the exocrine pancreas but no insulitis and no evidence of acute or chronic pancreatitis. Conclusions: Some patients with idiopathic type 1 diabetes have a nonautoimmune, fulminant disorder characterized by the absence of insulitis and of diabetes-related antibodies, a remarkably abrupt onset, and high serum pancreatic enzyme concentrations. (N Engl J Med 2000;342:301-7.) (C) 2000, Massachusetts Medical Society.
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页码:301 / 307
页数:7
相关论文
共 27 条
  • [1] Alberti KGMM, 1998, DIABETIC MED, V15, P539, DOI 10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO
  • [2] 2-S
  • [3] INSULIN-DEPENDENT DIABETES-MELLITUS AS AN AUTOIMMUNE-DISEASE
    BACH, JF
    [J]. ENDOCRINE REVIEWS, 1994, 15 (04) : 516 - 542
  • [4] Validity of screening for individuals at risk for type I diabetes by combined analysis of antibodies to recombinant proteins
    Christie, MR
    Roll, U
    Payton, MA
    Hatfield, ECI
    Ziegler, AG
    [J]. DIABETES CARE, 1997, 20 (06) : 965 - 970
  • [5] EISENBARTH GS, 1986, NEW ENGL J MED, V314, P1360
  • [6] THE HISTOPATHOLOGY OF THE PANCREAS IN TYPE-1 (INSULIN-DEPENDENT) DIABETES-MELLITUS - A 25-YEAR REVIEW OF DEATHS IN PATIENTS UNDER 20 YEARS OF AGE IN THE UNITED-KINGDOM
    FOULIS, AK
    LIDDLE, CN
    FARQUHARSON, MA
    RICHMOND, JA
    WEIR, RS
    [J]. DIABETOLOGIA, 1986, 29 (05) : 267 - 274
  • [7] ALTERED PATHOGENESIS IN ENCEPHALOMYOCARDITIS VIRUS (D-VARIANT)-INFECTED DIABETES-SUSCEPTIBLE AND RESISTANT STRAINS OF MICE
    GAINES, KL
    KAYES, SG
    WILSON, GL
    [J]. DIABETOLOGIA, 1986, 29 (05) : 313 - 320
  • [8] Gavin JR, 1997, DIABETES CARE, V20, P1183
  • [9] EXAMINATION OF ISLETS IN THE PANCREAS BIOPSY SPECIMENS FROM NEWLY DIAGNOSED TYPE-1 (INSULIN-DEPENDENT) DIABETIC-PATIENTS
    HANAFUSA, T
    MIYAZAKI, A
    MIYAGAWA, J
    TAMURA, S
    INADA, M
    YAMADA, K
    SHINJI, Y
    KATSURA, H
    YAMAGATA, K
    ITOH, N
    ASAKAWA, H
    NAKAGAWA, C
    OTSUKA, A
    KAWATA, S
    KONO, N
    TARUI, S
    [J]. DIABETOLOGIA, 1990, 33 (02) : 105 - 111
  • [10] HETEROGENEITY OF A HUMAN ISOLATE OF COXSACKIE-B4 - BIOLOGICAL DIFFERENCES
    HARTIG, PC
    WEBB, SR
    [J]. JOURNAL OF INFECTION, 1983, 6 (01) : 43 - 48