Association of fulminant type 1 diabetes with pregnancy

被引:55
作者
Shimizu, I
Makino, H [1 ]
Osawa, H
Kounoue, E
Imagawa, A
Hanafusa, T
Kawasaki, E
Fujii, Y
机构
[1] Ehime Univ, Sch Med, Dept Lab Med, Shigenobu, Ehime 7910295, Japan
[2] Matsuyama Red Cross Hosp, Matsuyama, Ehime, Japan
[3] Osaka Univ, Grad Sch Med, Osaka, Japan
[4] Osaka Med Coll, Osaka, Japan
[5] Nagasaki Univ, Sch Med, Unir Metab Diabet & Clin Nutr, Nagasaki 852, Japan
关键词
fulminant type 1 diabetes; pregnancy; viral infection; HLA; GADab;
D O I
10.1016/S0168-8227(03)00147-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
It has been reported that fulminant type 1 diabetes is a novel subtype of type 1B diabetes. However, whether the etiology of fulminant type 1 diabetes is associated with an autoimmune or nonautoimmune process remains to be solved. In order to further characterize fulminant type 1 diabetes, we compared the clinical, immunological and genetic characteristics with those of acute-onset type 1A diabetes. Nine patients with fulminant diabetes and nine patients with acute-onset type 1A diabetes, who had been newly diagnosed during 1998-2001, were analyzed. In female patients of child-bearing age, the onset of diabetes occurred during pregnancy or after delivery in three cases of six fulminant cases, but not in any of seven type 1A diabetes. Eight of nine fulminant patients had fever immediately prior to the onset of hyperglycemic symptoms, whereas only one of nine type 1A patients had this (P = 0.002). In Japanese type 1 susceptible HLA haplotypes, DRB1*0901-DQB1*0303 was more frequent in type 1A diabetes than fulminant diabetes (7/18 vs. 0/18, P = 0.004), whereas the frequency of DRB1*0405-DQB1*0401 was similar (type 1A 4/18 vs. fulminant 6/18). Therefore, pregnancy, possible viral infection, or HLADRB1*0405-DQB1*0401 may contribute to the onset of fulminant type 1 diabetes. (C) 2003 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:33 / 38
页数:6
相关论文
共 10 条
[1]  
BUSHARD K, 1987, BRIT MED J, V294, P275
[2]   A novel subtype of type 1 diabetes mellitus characterized by a rapid onset and an absence of diabetes-related antibodies. [J].
Imagawa, A ;
Hanafusa, T ;
Miyagawa, J ;
Matsuzawa, Y .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (05) :301-307
[3]   Rapid-onset type 1 diabetes with pancreatic exocrine dysfunction. [J].
Lernmark, Å .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (05) :344-345
[4]   Immunology at the maternal-fetal interface: Lessons for T cell tolerance and suppression [J].
Mellor, AL ;
Munn, DH .
ANNUAL REVIEW OF IMMUNOLOGY, 2000, 18 :367-391
[5]   Type 1A diabetes induced by infection and immunization [J].
Robles, DT ;
Eisenbarth, GS .
JOURNAL OF AUTOIMMUNITY, 2001, 16 (03) :355-362
[6]   Rapid loss of insulin secretion in a patient with fulminant type 1 diabetes mellitus and carbamazepine hypersensitivity syndrome [J].
Sekine, N ;
Motokura, T ;
Oki, T ;
Umeda, Y ;
Sasaki, N ;
Hayashi, M ;
Sato, H ;
Fujita, T ;
Kaneko, T ;
Asano, Y ;
Kikuchi, K .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 285 (09) :1153-1154
[7]   Autoantibodies to multiple islet autoantigens in patients with abrupt onset type 1 diabetes and diabetes diagnosed with urinary glucose screening [J].
Sera, Y ;
Kawasaki, E ;
Abiru, N ;
Ozaki, M ;
Abe, T ;
Takino, H ;
Kondo, H ;
Yamasaki, H ;
Yamaguchi, Y ;
Akazawa, S ;
Nagataki, S ;
Uchigata, Y ;
Matsuura, N ;
Eguchi, K .
JOURNAL OF AUTOIMMUNITY, 1999, 13 (02) :257-265
[8]  
Shimizu Ikki, 2001, Journal of the Japan Diabetes Society, V44, P315
[9]   Clinical, autoimmune, and genetic characteristics of adult-onset diabetic patients with GAD autoantibodies in Japan (Ehime study) [J].
Takeda, H ;
Kawasaki, E ;
Shimizu, I ;
Konoue, E ;
Fujiyama, M ;
Murao, S ;
Tanaka, K ;
Mori, K ;
Tarumi, Y ;
Seto, I ;
Fujii, Y ;
Kato, K ;
Kondo, S ;
Takada, Y ;
Kitsuki, N ;
Kaino, Y ;
Kida, K ;
Hashimoto, N ;
Yamane, Y ;
Yamawaki, T ;
Onuma, H ;
Nishimiya, T ;
Osawa, H ;
Saito, Y ;
Makino, H .
DIABETES CARE, 2002, 25 (06) :995-1001
[10]  
Tanaka S, 2000, NEW ENGL J MED, V342, P1835