自发酮症起病的糖尿病87例临床特征及分型探讨

目的探讨自发酮症起病的糖尿病的临床特征及分型。方法将2003-01～2004-05南京鼓楼医院收治的自发酮症起病的糖尿病患者(87例)根据自身抗体阳性与否,分为抗体阴性组(67例)及抗体阳性组(1A型糖尿病组)(20例)。抗体阴性的患者依据是否依赖胰岛素治疗,进一步分为胰岛素依赖组(27例)及非胰岛素依赖组(40例)。不同组别的临床特征、生化指标之间进行比较。结果抗体阴性组男性发生率显著高于女性;具明显的家族遗传倾向;起病时体重指数显著高于1型糖尿病组,甘油三酯水平高于其他两组;空腹及餐后2hC肽水平介于2型及1型糖尿病组之间。胰岛素依赖组较胰岛素非依赖组具更强的男性易患性;超重和肥胖患者所占比例较低;酮症程度较重;血糖及空腹C肽水平两组之间差异无显著性;3个月后空腹C肽水平,非胰岛素依赖组显著高于胰岛素依赖组。结论酮症起病的糖尿病依据抗体阳性与否,分为抗体阴性和抗体阳性酮症起病的糖尿病,后者即为1A型糖尿病。抗体阴性酮症起病的糖尿病可依据是否依赖胰岛素治疗,分为酮症起病的2型糖尿病和特发性1型糖尿病(1B型糖尿病)。     

1型糖尿病患者的临床特点和多种胰岛自身抗体检出情况

目的分析1型糖尿病（T1DM）患者多种胰岛自身抗体的检出情况和不同类型T1DM的临床特征。方法选取2010年11月至2011年11月在中日友好医院住院的67例T1DM患者,分析其临床特征及胰岛细胞抗体（ICA）、胰岛素抗体（IAA）、谷氨酸脱羧酶抗体（GADA）[酶联免疫吸附试验（ELISA）法和免疫沉淀法（RIP）检测]、蛋白酪氨酸磷酸酶抗体（IA2A）和锌转运蛋白8抗体（ZnT8A）等6种胰岛自身抗体情况。结果本组T1DM共67例,其中经典型T1DM53例,成人迟发性自身免疫糖尿病（LADA）12例和暴发性1型糖尿病（FT1D）2例。起病年龄2～77岁,体质指数（BMI）（22±4）kg／m2,糖化血红蛋白（HbAlc）9．7％±2．4％,空腹C肽（0．3±O．4）μ／L。GADA（ELISA）阳性51例（76．1％）,GADA（RIP）阳性35例（52．2％）,IA2A阳性19例（28．3％）,ZnT8A阳性16例（23．9％）,IAA阳性16例（23．9％）,ICA阳性10例（14．3％）。前4种抗体检测方法至少1种阳性者共56例（83．6％）。51例ELISA法GADA阳性包括了35例RIP检测GADA阳性中的33例、19例IA2A阳性中15例及16例ZnT8A阳性中的14例。经典1型糖尿病在发病初至半年内需要胰岛素治疗,而LADA平均在发病3．9年后需要胰岛素治疗。2例FT1D患者起病急,发病时血糖分别为41．1和23．1mmol／L,HbAlc分别为7．8％和6．5％,空腹及餐后血C肽均小于0．03μg／L或不能测出。结论ELISA检0n．0GADA对1型糖尿病的诊断有较高敏感性,联合多种抗体检测对T1DM诊断作用有限。FT1D起病急骤,代谢紊乱更为严重。     

SOX13抗体对急性起病自身免疫糖尿病的诊断意义

目的探讨SOX13抗体(SOX13Ab)对急性起病自身免疫糖尿病的诊断价值。方法162例急性起病糖尿病患者根据谷氨酸脱羧酶抗体(GADAb)和蛋白酪氨酸磷酸酶抗体(IA2Ab)阳性与否分为经典[GADAb和(或)IA2Ab阳性]和非经典1型糖尿病(DM)(GADAb和IA2Ab均阴性)两亚组,正常对照组120名,分析SOX13Ab分布规律、该抗体阳性患者临床特征及其对胰岛功能的影响。结果(1)急性起病组和经典1型DM亚组SOX13Ab阳性率均高于正常对照组(9.3%vs2.5%,9.9%vs2.5%;均P<0.05);SOX13Ab( )/GADAb( )双阳性者6例(3.7%),无1例SOX13Ab( )/IA2Ab( )双阳性者;(2)SOX13Ab分布峰值处于发病年龄61～70岁;(3)SOX13Ab单一阳性组临床特征(包括代谢综合征相关指标异常程度等)与GADAb、IA2Ab单一阳性和抗体阴性组间差异无统计学意义(P>0.05);(4)SOX13Ab单一阳性组C肽介于GADAb、IA2Ab单一阳性和抗体阴性组之间。结论SOX13Ab检测可提高诊断急性起病自身免疫糖尿病的敏感性。     

胰岛素自身抗体对成人隐匿性自身免疫糖尿病的诊断价值

目的 探讨胰岛素自身抗体(IAA)对成人隐匿性自身免疫糖尿病(LADA)的诊断价值.方法 选取2003年10月至2007年3月连续在中南大学湘雅二医院就诊的1003例初诊2型糖尿病、110例1型糖尿病患者,并选取同期米院体格检杏的317名健康对照者,采用微量平板放射免疫法和放射配体法检测IAA及谷氨酸脱羧酶抗体(GADA)和蛋门酪氨酸磷酸酶抗体(IA-2A)水平,了解IAA阳性率及与其他抗体重叠情况.对4例IAA单独阳性的LADA患者进行了4年随访,观察其临床特征变化.采用卡方榆验比较初诊2型糖尿病组、健康对照组和初诊1型糖尿病组IAA阳性率,采用t检验比较IAA阳性组和阴性匹配组空腹胰岛素(FINS)水平下降速率.结果 (1)初诊2型糖尿病患者IAA阳性率3.39%(34/1003)高于健康埘照组0.95%(3/317)(X2=5.3,P<0.05),但低于1型糖尿病组21.82%(24/110)(x2=68.2,P<0.01).(2)初诊2型糖尿病患者三种抗体联合检测阳性率为10.47%(105/1003),高于GADA 6.58%(66/1003)、IA-2A 2.79%(28/1003)、IAA3.39%(34/1003)单个抗体检测(x2值分别为9.2、37.8和46.2,P值均<0.05).IAA联合检测可提高LADA阳性检出率2.39%.(3)在4年随访期间,IAA阳性者逐年转阴,4例中的2例患者合并GADA阳性;IAA阳性组FINS水平下降速率较阴性匹配组呈增高趋势(分别为15.37%和5.29%;t=1.7,P=0.059).结论 IAA对初诊2型糖尿病患者筛查LADA有一定价值;联合检测IAA、GADA、IA-2A能提高LADA诊断效率.     

应用HLA-DQ基因型对自身抗体阴性1型糖尿病的再分型

目的 探讨自身抗体阴性1型糖尿病患者疾病表型与HLA-DQ基因型之间的关系,以及HLA-DQ基因型可否对自身抗体阴性的1型糖尿病再分型。方法61例自发酮症起病的糖尿病患者纳入本研究,检测其谷氨酸脱羧酶抗体、酪氨酸磷酸酶抗体及甲状腺自身抗体,并进行HLA-DQ基因分型。根据1型糖尿病HLA-DQ易感基因型的有无,将抗体阴性组进一步分为有HLA-DQ易感基因型组(A组)和无HLA-DQ易感基因型组(B组)。比较抗体阳性组与抗体阴性组、A组与B组在起病状况、临床特征等方面的差异。结果61例患者中,32例(52．5％)存在一种或多种血清自身抗体。29例自身抗体阴性的患者中,18例携带1～4个1型糖尿病HLA-DQ易感基因型(即为A组),另11例不携带1型糖尿病HLA-DQ易感基因型(即为B组)。与抗体阴性组相比,抗体阳性组存在发病年龄较年轻、体重指数(BMI)较低、发病时酮症酸中毒程度较严重、C肽水平较低等特点。与B组相比,A组患者具有在发病时酮症酸中毒程度较严重、C肽水平较低、BMI较低等特征。结论自身抗体阴性的1型糖尿病患者中,携带HLA-DQ易感基因型者显示出更接近1A型糖尿病的临床特征,需进一步研究此类患者中可能存在的某种未能检测出的自身免疫反应。HLA-DQ基因型可对自身抗体阴性的1型糖尿病再分型;在诊断1B型糖尿病时需排除携带HLA-DQ易感基因型者。     

对新诊断的糖尿病患者筛查谷氨酸脱羧酶抗体的意义

目的 探讨筛查谷氨酸脱羧酶抗体(GADA)对新诊断糖尿病患者的临床意义.方法 分析200例糖尿病患者的生化特点,采用酶联免疫法测定GADA,放射免疫法测定血清C肽,并进行统计分析.结果 200例新诊断的糖尿病患者中,GADA阳性者15例,占7.5%;GADA阳性组患者较阴性组患者体重指数低(P＜0.01)、空腹及餐后2 h血清C肽水平低(P＜0.01),酮症发生率明显升高(P＜0.01);年龄、血糖、血脂及糖化血红蛋白值,两组比较差别无统计学意义(P＞0.05).结论 对新诊断的糖尿病患者进行GADA筛查,抗体阳性患者因其胰岛细胞功能较差,应尽早采用胰岛素降糖治疗,可延缓胰岛细胞功能衰竭及糖尿病慢性并发症的发生.     

1型糖尿病起病过程的临床异质性分析

目的 了解1型糖尿病起病过程的临床异质性.方法 回顾性分析自1999年1月至2009年12月广州中山大学附属第一医院内分泌科205例新诊断1型糖尿病患者的临床资料.根据症状出现至就诊时间,将患者分为暴发性1型糖尿病（FT1DM）、急性起病及缓慢起病的1型糖尿病（出现症状至就诊时间分别≤或＞3个月）,比较3组患者临床特点及实验室检查资料.血清谷氨酸脱羧酶抗体（GADA）、胰岛细胞自身抗体（ICA）、胰岛素自身抗体（IAA）均为定性检测,GADA采用酶联免疫吸附法（ELISA）,ICA、IAA及血清C肽检测采用放射免疫法.计量资料采用单因素方差分析或两个独立样本的t检验,计数资料采用多变量卡方检验及Fisher精确概率法进行统计分析.结果 FT1DM、急性起病及缓慢起病的1型糖尿病分别占8.8%、66.8%及24.4%.3组中FT1DM患者血糖升高更明显[分别为（31±12）、（25±10）、（24±8）mmol/L,F=4.462,P＜0.05],而糖化血红蛋白略高于正常[分别为（6.8±1.1）%、（12.3±2.4）%、（13.9±2.7）%,F=54.661,P＜0.05],酮症酸中毒更常见（分别为93.8%、45.3%、8.0%,F=44.943,P=0.000）,合并低钠血症、高钾血症、酸中毒、肝肾功能受损更严重,合并妊娠的比例更高（分别为22.2%、0、0,X2=20.982,P=0.000）.缓慢起病的1型糖尿病患者起病年龄及体质指数较另两组大,而体质量下降更明显,负荷后C肽水平明显高于另外两组[分别为（0.40±0.36）、（0.10±0.13）、（0.34±0.26）nmol/L,F=8.752,P＜0.05].儿童及青少年在急性起病的1型糖尿病中所占比例更高,其临床表型与成人相似.结论3组患者起病过程的临床异质性十分明显,提示1型糖尿病可能存在不同的疾病触发机制.     

探讨儿童及青少年暴发性1型糖尿病分型的临床意义

目的 调查暴发性1型糖尿病（FT1D）的发病情况及临床特点,明确该亚型在儿童及青少年中分型的临床意义.方法 调查2004年1月至2012年12月我院新确诊的18岁以下1型糖尿病（T1D）患者,共853例,根据FT1D的诊断标准共筛出11例FT1D.依照相同性别、相近年龄（±2岁）、相同季节、相同年份在我院糖尿病病例库中按1：4的比例进行匹配,选取经典型T1D44例.总结两组的临床特点、实验室检查,随访至少1年的临床结局.结果 853例中,以酮症（DK）或酮症酸中毒（DKA）急性起病的经典1型者468例,符合FT1D诊断标准的患者11例（男孩6例）,暴发性占所有T1D的1.29％,占DK或DKA急性起病的T1D的2.35％.暴发组与经典组相比,除体质指数（BMI）差异有统计学意义外,在急重症并发症发生率、治疗后蜜月期发生率及持续时间、电解质紊乱程度等方面差异均无统计学意义.结论 18岁以下患者FT1D发生比例极低,与经典T1D相比,未显示出明显差异.但由于病例较少,需要积累数据进一步探究该亚型分型的临床意义.     

谷氨酸脱羧酶抗体水平对两种成人隐匿性自身免疫糖尿病亚型的识别

目的　探讨不同谷氨酸脱羧酶 (GAD65)抗体水平的成人隐匿性自身免疫糖尿病(LADA)患者的临床特点 ,了解LADA患者中是否存在两种不同的亚型。方法　对 750例临床初诊为2型糖尿病 (T2DM)患者及其志愿参加进一步研究的 2 95例患者用放免法进行GAD65抗体 (GADA)测定 ,绘制GADA指数的频数分布图 ,进行各组间临床特点的比较。结果　 (1 )GADA在初诊 2型糖尿病中的阳性率为 9 7% ,高抗体水平者 (GADA指数≥ 0 5)占 2 8%。 (2 )LADA患者中抗体滴度较低(GADA指数 0 0 5～ <0 5)者在胰岛功能 (空腹C肽 50 0pmol/L比 50 4pmol/L ,P >0 0 5)、高血压比例(48 7%比 42 5 % ,P >0 0 5)及体重指数 (2 3 2kg/m2 比 2 2 3kg/m2 ,P >0 0 5)等方面与 2型糖尿病相似 ,即为LADA 2型 ;抗体滴度较高者 (GADA指数≥ 0 5)具有起病年龄小、胰岛功能差、更多使用胰岛素治疗 (P <0 0 1 )等特点 ,临床表现更类似经典的 1型糖尿病 ,即为LADA 1型。结论　LADA患者具有异质性 ,存在LADA 1和LADA 2两种亚型 ,LADA 1型的临床特点更类似于经典的 1型糖尿病     

以酮症起病的成年糖尿病患者自身免疫指标与尿微量白蛋白关系的探讨

目的：研究以酮症起病的成年糖尿病患者自身抗体和免疫球蛋白水平与尿微量白蛋白的关系。方法：回顾性分析42例首诊表现有酮症的成年糖尿患者（K组）和30例新发无酮症倾向的2型糖尿病患者（c组）尿微量白蛋白、谷氨酸脱羧酶抗体（GADAb）、胰岛细胞抗体（ICA）、免疫球蛋白（IgA、IgG、IgM）等指标。以GADAb和／或ICA阳性与否再分为胰岛自身抗体阳性组（A组）和抗体阴性组（B组），对比上述指标。结果：K组尿微量白蛋白阳性率（24h尿微量白蛋白〉30mg为阳性）、GADAb和／或ICA阳性率和IgG水平高于C组；A组尿微量白蛋白阳性率、IgG水平高于B组。结论：以酮症起病的成年糖尿病患者尿微量白蛋白升高与自身免疫异常相关（R=0．621）。     

Fulminant type 1 diabetes in Korea: high prevalence among patients with adult-onset type 1 diabetes

Aims/hypothesis The aim of this study was to investigate the prevalence of fulminant type 1 diabetes and the clinical characteristics of the disease among newly diagnosed Korean patients. Methods Using data retrieved from the Seoul National University Hospital database, we identified all patients newly diagnosed with type 1 diabetes from 1 January 1999 to 31 July 2006. Information on clinical manifestations and laboratory data, including the presence of islet autoantibodies detected at diagnosis, were obtained by reviewing medical records. Results We identified 99 patients newly diagnosed with type 1 diabetes. Seven patients (7.1%) fulfilled the criteria for fulminant type 1 diabetes. Among the patients aged ≥18 years at onset, 30.4% had fulminant type 1 diabetes. Patients with this diabetes subtype tested negative for islet autoantibodies, had a higher age of onset (median 28 vs 10 years, p < 0.001) and a markedly shorter duration from onset of hyperglycaemic symptoms to first hospital visit (median 3 vs 30 days, p < 0.001) than patients with non-fulminant type 1 diabetes, and showed trends of increased serum aspartate aminotransferase and amylase levels and a decreased glucagon-stimulated serum C-peptide response. Conclusions/interpretation In Korea, the prevalence of fulminant type 1 diabetes was 7.1% among all patients newly diagnosed with type 1 diabetes and 30.4% among patients with adult-onset diabetes. The clinical and metabolic characteristics of the patients with fulminant type 1 diabetes were similar to those reported in Japanese studies. Y. M. Cho and J. T. Kim contributed equally to this work.     

暴发性1型糖尿病的特点与诊治

1型糖尿病包括自身免疫性(1A)和特发性(1B)两种类型.近年发现了一种发展更为迅速、病情更为严重的暴发性1型糖尿病.这类患者占酮症或酮症酸中毒起病的1型糖尿病的15%～20%.该病与HLA Ⅱ类抗原和病毒感染有一定联系.由于起病急骤,虽然患者的血糖很高,但HbA_(1C)水平几乎正常.因此凡遇到超高血糖而HbA_(1C)接近正常的酮症酸中毒患者,应考虑暴发性1型糖尿病的诊断.对该病的治疗和1型糖尿病没有区别,但因其发展迅速,抢救更应及时.     

Delta infection and hepatitis B virus replication in Danish patients with fulminant hepatitis B

The presence of hepatitis B virus and delta agent markers was investigated in 41 patients referred during the years 1970-1985 with fulminant hepatitis classified as type B or non-A non-B and compared to findings in patients with uncomplicated hepatitis B and chronic hepatitis B infection. 13 patients had no markers of hepatitis B and delta infection and were classified as non-A non-B hepatitis. The remaining 28 patients were all HBsAg and IgM anti-HBc positive and 14 (50%) had evidence of delta infection. In contrast, only 13/71 patients (18%) with acute benign hepatitis B had evidence of delta coinfection (p less than 0.005). This corresponds to an odds ratio of 4.5 for development of fulminant hepatitis among patients with hepatitis B and delta coinfection. In 100 chronic HBsAg carriers 29% were positive for delta markers. 12 of the delta infected patients with fulminant hepatitis were positive for total antibody to the delta antigen, and 2 were delta antigen positive. Three were HBeAg positive/anti-HBe negative. None had hepatitis B virus DNA. Among the 14 patients without delta infection, hepatitis B virus DNA was found in 2/4 HBeAg positive/anti-HBe negative patients and in 1/8 patients negative for both markers. The present data indicate that a high proportion of Danish patients with fulminant hepatitis B have hepatitis B and delta agent coinfection. Further, the findings suggest that hepatitis B and delta coinfection may be associated with an increased risk of development of fulminant hepatitis as compared to that of hepatitis B alone.     

六例暴发性1型糖尿病患者临床特征分析

目的 比较分析暴发性1型糖尿病及经典1型糖尿病的临床特征,探讨暴发性1型糖尿病的发病机制.方法 入选2005年9月至2009年9月在我院内分泌科住院的以酮症酸中毒为首发症状的暴发性1型糖尿病患者6例(暴发性1型糖尿病组)和以酮症酸中毒为首发症状的初发经典1型糖尿病患者24例(经典1型糖尿病组),回顾性分析两组患者的临床特征,包括发病年龄、糖尿病病程、咽痛、咳嗽、发热等流感样症状、恶心、呕吐、腹痛等消化道症状、入院时随机血糖、糖化血红蛋白、C肽、丙氨酸转氨酶、肌酸激酶、肌酐、血钾、白细胞计数等.计量资料和计数资料分别采用t检验或x2检验进行统计分析.结果 与经典1型糖尿病组相比,暴发性1型糖尿病组发病年龄升高[分别为(46±6)、(19±6)岁,t=9.89,P＜0.01],糖尿病病程明显缩短[分别为(3.5±2.7)、(52.5±32.6)d,t=3.63,P＜0.01],咽痛、咳嗽、发热等流感样症状明显增多[分别为50%(3/6)、0(0/24),x2=13.33,P＜0.01],恶心、呕吐、腹痛等消化道症状亦增多[分别为83%(5/6)、0(0/24),x2=24.00,P＜0.01].与经典1型糖尿病组相比,暴发性1型糖尿病组入院时随机血糖升高[分别为(44±7)、(23±4)mmol/L,t=9.22,P＜0.01],糖化血红蛋白降低[分别为(7.1±1.0)%、(14.4±2.2)%,t=7.66,P＜0.01],餐后2 h C肽减少[分别为(0.21±0.17)、(0.58±0.39)μg/L,t=2.29,P＜0.05],丙氨酸转氨酶增高[分别为(206±124)、(10±2)U/L,t=8.18,P＜0.01],肌酸激酶升高[分别为(1038±447)、(79±10)U/L,t=11.11,P＜0.01],肌酐增加[分别为(179±39)、(55±16)μmol/L,t=12.33,P＜0.01],血钾升高[分别为(5.2±0.7)、(3.4±0.8)mmol/L,t=5.07,P＜0.01],白细胞计数增多[分别为(21.0±8.1)×109个/L、(6.0±1.9)×109个/L,t=8.64,P＜0.01].结论 暴发性1型糖尿病患者存在胰岛β细胞功能衰竭,代谢紊乱更为严重,免疫反应更加强烈,容易导致多脏器功能损害.     

Clinical heterogeneity of type 1 diabetes (T1D) found in Asia

Diabetes mellitus among young patients in Asia is caused by a complex set of factors. Although type 1 diabetes (T1D) remains the most common form of diabetes in children, the recent unabated increase in obesity has resulted in the emergence of type 2 diabetes (T2D) as a new type of diabetes among adolescents and young adults. In addition to the typical autoimmune type 1 diabetes (T1aD) and T2D patients, there is a variable incidence of cases of non‐autoimmune types of T1D associated with insulin deficiency (T1bD). Additional forms have been described, including fulminant T1D (FT1D). Although most diagnoses of T1D are classified as T1aD, fulminant T1D exists as a hyper‐acute subtype of T1D that affects older children, without associated autoimmunity. Patient with this rare aetiology of diabetes showed a complete loss of β‐cell secretory capacity without evidence of recovery, necessitating long‐term treatment with insulin. In addition, latent autoimmune diabetes in adults is a form of autoimmune‐mediated diabetes, usually diagnosed during the insulin‐dependent stage that follows a non‐insulin requiring phase, which can be diagnosed earlier based on anti‐islet autoantibody positivity. Some reports discuss T1bD. Others are elaborating on the presence of “atypical T1b diabetes,” such as Flatbush diabetes. The prevalence of diabetes mellitus in young adults continues to rise in Asian populations as T2D increases. With improved characterization of patients with diabetes, the range of diabetic subgroups will become even more diverse in the future. Distinguishing T1D, T2D, and other forms of diabetes in young patients is challenging in Asian populations, as the correct diagnosis is clinically important and has implications for prognosis and management. Despite aetiological heterogeneity in the usual clinical setting, early diagnosis and classification of patients with diabetes relying on clinical grounds as well as measuring islet autoantibodies and fasting plasma C‐peptide could provide a possible viable method to minimize complications.     

暴发性1型糖尿病临床流行病学调查

目的了解住院糖尿病患者中暴发性1型糖尿病的患病状况。方法采用Hanafusa提出的标准诊断暴发性1型糖尿病。系统性回顾2001～2008年本院内分泌科住院糖尿病患者情况,分析暴发性1型糖尿病所占比例。结果8年间本院内分泌科住院糖尿病患者共8801例,其中新诊断急性起病1型糖尿病患者107例,暴发性1型糖尿病患者为11例。暴发性1型糖尿病约占本院连续住院糖尿病患者的1‰,新发1型糖尿病患者的10％。未观察到暴发性1型糖尿病发病逐年增加及月份聚集现象。结论暴发性1型糖尿病呈散发,成年人中常见,临床中应注意鉴别诊断。     

The Swedish childhood diabetes study III: IgM against coxsackie B viruses in newly diagnosed Type 1 (insulin-dependent) diabetic children — no evidence of increased antibody frequency

Summary Sera from essentially all Swedish children aged 0–14 years with Type 1 (insulin-dependent) diabetes mellitus with onset during an autumn period (October–December 1985) and a late spring period (May–June 1986) were selected. In all, 98 patients were analysed for IgM antibodies against coxsackie B virus serotypes 1 through 5 by a -antibody capture radio immunoassay technique. Sera from 94 referent children matched for age, sex and residential area, collected during the same period, were also analysed. During the autumn period, 10 out of 67 (15%) diabetic children were IgM positive while 14 out of 75 (19%) of the healthy referent children demonstrated positivity. During the late spring period only one out of 31 (3%) children with diabetes and two out of 19 (10%) referent children were IgM positive. In the diabetic patients, five were coxsackie B2 positive while coxsackie B1, 3, 4 and 5 were represented by one to three patients each. Eight referent children were coxsackie B4 positive, six were B3 positive and two B2 positive, while no referent children were positive against coxsackie B1 and 5. During these two periods in late 1985 and early 1986 these data demonstrate no evidence of increased antibody frequency against coxsackie B virus 1 through 5 at the onset of childhood diabetes in Sweden.