成人隐匿性自身免疫糖尿病研究的新进展

成人隐匿性自身免疫糖尿病(latent autoimmune diabetes in adults,LADA)属于自身免疫性缓慢起病的1型糖尿病,但其早期临床表现与2型糖尿病相似。LADA与经典1型糖尿病的自身免疫发病机制相同,不同之处在于其胰岛β细胞所受免疫损害呈缓慢性,因此LADA可作为进行1型糖尿病免疫学研究的一种人类模型。LADA的诊断目前尚无统一的国际标准,应从临床特征、易感基因、细胞和体液免疫标志、组织病理等方面综合考虑,其中胰岛自身抗体是诊断LADA的重要指标。早期应用胰岛素治疗有助于保护部分LADA患者残存的胰岛细胞功能。研究具有不同抗体滴度LADA患者的病理改变有助于了解β细胞的免疫破坏进程,尝试新的免疫干预措施,从而可能为1型糖尿病的预防甚至治愈提供依据。

Latent autoimmune diabetes in adults: an update

Latent autoimmune diabetes in adults (LADA),presenting with a similar phenotype of type2diabetes at early stage,belongs to the slowly progressive subtype of autoimmune type1diabetes.LADA differs from classic juvenile-onset type1diabetes in which its autoimmune destructive process of islet beta-cells is much slower,so LADA may serve as a human model of autoimmune type1diabetes.Although no international standardized criteria for the diagnosis of LADA has been established,it should be noted that LADA has some specific features in clinical characteristics,susceptible genotypes,cellular and humoral immune markers,as well as islet pathology.Presence of islet autoantibodies is necessary for the diagnosis of LADA.Early insulin intervention may preserve residual islet beta-cell function in LADA.The different pathological manifestations of LADA with different autoantibody titers can help throw light on the autoimmune process,laying foundation of prevention or even cure of type1diabetes.