AACE2012：1型糖尿病的预测和预防
2012-06-05 11:43:39 来源：
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1、Drugs aimed at halting the molecular destruction of beta cells are likely the next step in the quest to stop the progression of autoimmune type 1 diabetes, according to research presented here at the American Association of Clinical Endocrinologists 21st Annual Meeting and Clinical Congress by a pioneer in the field.
据这方面的先驱发表在美国临床内分泌医师协会第二十一届年会临床讨论会的研究报告，保护β细胞分子不破坏的药物的研究很可能是阻止自身免疫性1型糖尿病进展的下一个步骤。
2、"Most of the trials we do in are in recent-onset type 1 diabetes, when there are plenty of beta cells left — probably at least 20%.... If one could preserve them, it would be much easier to control patients; it's like the honeymoon phase," said George Eisenbarth, MD, PhD, executive director of the Barbara Davis Center for Childhood Diabetes and professor of pediatrics, medicine, and immunology at the University of Colorado at Denver School of Medicine.
科罗拉多大学丹佛医学院分校医学免疫学家、巴巴拉戴维斯中心儿童糖尿病执行主任和儿科教授、医学博士乔治·艾森巴特说：“我们做的大部分的实验是取材于近期发生的1型糖尿病，有大量的β细胞（可能至少20%）存活，如果能维持它们，那控制患者的血糖将非常容易，像是处于糖尿病蜜月期。”
3、Today, autoantibody testing can predict an individual's risk of developing autoimmune type 1 diabetes, and even the age of onset of the disorder — information that could one day guide the use of such preventive therapy, said Dr. Eisenbarth.
艾森巴尔斯博士说：“当代抗体测试可以预测一个人发展成自身免疫性1型糖尿病的风险，甚至疾病出现的年龄，这将指导未来某一天预防性治疗自身免疫性1型糖尿病。”
4、Such testing in random cadaveric donors suggests that half a million people in the United States might be in the early stages of developing type 1 diabetes, Dr. Eisenbarth wrote in a recent paper (Endocr Pract. Published online May 1, 2012), underscoring the urgency of finding preventive drugs.
最近艾森巴尔斯博士写的文件（2012年5月1日在线发表，Endocr Pract）表示：在随机尸体捐赠者进行抗体测试表明，一百万美国人中有一半人可能是处于1型糖尿病早期发展阶段，并强调迫切需要寻找预防性药物。
5、Because the development of type 1 diabetes is a slow process, requiring genetic predisposition and a precipitating trigger followed by the gradual development of beta cell loss, prevention is a realistic goal.
因为1型糖尿病是一个需要遗传易感性和β细胞损失积累触发的缓慢发展过程，所以预防是一个现实的目标。
6、People with genetic predispositions can develop type 1 diabetes at any stage in life, he explained. "If one is an identical twin of someone with type 1A diabetes, you're never out of the woods — autoantibodies can appear later in life and full-blown diabetes even later," he said. A second peak in the incidence of the disorder is seen in people 70 to 80 years of age, he added.
有遗传易感性的人在生命任何阶段都有可能发展为1型糖尿病患者，他解释说：“如果同卵双胞胎中一个有1A型糖尿病，另一个也不会幸免，自身抗体晚些出现或甚至更晚出现晚期糖尿病。”疾病发生第二高峰是在70到80岁，他补充说。
7、To date, 4 autoantibodies are implicated in the development of type 1 diabetes: the islet zinc transporter (ZnT8), insulinoma associated antigen, glutamic acid decarboxylases, and insulin autoantibodies.
迄今，4种抗体与1型糖尿病的发展有牵连：胰岛锌转运体（ZnT 8），胰岛素瘤相关抗原，谷氨酸脱羧酶，与胰岛素自身抗体。
8、Commercial assays are available for all 4 autoantibodies, enabling the screening of people with a family history of the disorder.
4种抗体的商业产品是有价值的，能够筛选有家族病史的人。
9、Detection of a single antibody suggests a risk of developing type 1 diabetes of about 5%, compared with 0.3% in the general population. However, in people with 2 or more autoantibodies, the risk is much higher — up to a 90% by the age of 10 in children followed from birth.
检测到单一抗体时表明，发展成1型糖尿病的风险约为5%，相比下总人口中的发病率是0.3%。然而，检测到2个或更多的抗体时，从出生之后到10岁儿童发展成1型糖尿病的风险高达90%。
10、"Not only can we predict risk, now we can also predict the age at which type 1 diabetes will occur," said Dr. Eisenbarth, explaining that there are 2 factors that predict age at onset. "If you combine these 2 parameters, you can explain about a third of the variation in age at which type 1 diabetes develops," he said.
“我们不仅可以预测风险，现在我们也可以预测1型糖尿病的发生的年龄，”艾森巴尔斯博士解释说目前有2个因素可用来预测发病年龄，“如果你把这2个参数结合起来，你可以解释1型糖尿病发展与年龄的大约三分之一变化。”
11、The first factor is the person's age at autoantibody detection; "that makes sense if we think that the autoimmune process begins when that first autoantibody appears," he said. "Overall, the older you are when the first autoantibody appears, the older you are when diabetes occurs."
自身抗体检测的第一个因素是年龄，他说：“如果我们认为自身免疫开始于第一次抗体的出现，是有道理的。总的来说，第一次抗体的出现的年龄越大，糖尿病发生的年龄也就越大。”
12、The second predictive factor is the level of insulin autoantibody at first detection. "This is specific for insulin [autoantibody]," he said. "The levels of none of the other autoantibodies correlated at all with how long it takes to develop type 1 diabetes."
第二预测因素是第一次检测时胰岛素抗体水平。他说：“胰岛素[抗体]检测信息详细，没有其他自身抗体的水平能反应1型糖尿病发展的时间。”
13、Currently, oral insulin (to induce tolerance) and immunosuppressive or immunomodulating drugs have been shown to preserve beta cells and to delay diabetes onset for 6 months to 1 year. However, work by Dr. Eisenbarth's team is directed at more specific therapies that target the trimolecular complex: the interaction of peptides, T-cell receptors, and major histocompatibility complex molecules.
目前，口服胰岛素（诱导耐受）和免疫抑制或免疫调节药物显示出保护β细胞及延缓糖尿病推迟6个月至1年发病的作用。然而，艾森巴尔斯博士的团队工作针对的是更具体的分子复合物治疗：相互作用的多肽，T细胞受体，和主要组织相容性复合分子。
14、"I bet...we're going to be able to — in many different ways — target this trimolecular complex, and hopefully develop a very specific and safe therapy," he said. 'It's unusual to have a disease that we can predict so well, and know the autoimmunity, and not have an immunologic therapy in our armamentarium."
他说：“我打赌……我们会用许多不同的方式——瞄准这个分子复合物，并希望建立一个非常具体和安全的治疗。而有一种我们可以很好预测的疾病，并知道是由自身免疫导致的，而在我们的医疗设备中没有使用免疫疗法——这是不寻常的。”
15、The availability of autoantibody testing for type 1 diabetes autoantibodies is important to practicing clinicians, according to endocrinologists Shivani Narasimhan, MD, and Parul Kakaria, MD, from the Pinnacle Health System in Harrisburg, Pennsylvania, who attended the session.
1型糖尿病自身抗体检测是很重要的临床实践，根据出席会议的内分泌家什瓦尼纳拉辛汉博士和宾夕法尼亚哈里斯堡顶级卫生系统parul kakaria医学博士的观点。
16、Dr. Eisenbarth's lab "will screen family members between the ages of 2 and 45 for autoantibodies; that is very practical to me," said Dr. Narasimhan.
纳拉辛汉博士说：“艾森巴尔斯博士的实验室将筛选年龄介于2到45岁家庭成员的自身抗体，这对于我来说是非常实用的。”
17、Physicians and patients who want to know more can call 1-800-HALT-DM1 (1-800-425-8361) or visit the TrialNet Web site.
想知道更多的医生或患者可拔打打1-800-halt-dm1（1-800-425-8361）或访问 TrialNet Web site。
18、Dr. Narasimhan said that her adult patients with type 1 diabetes are "very much concerned" about the risk of other family members and offspring developing the disease. "If they're planning on having children or have just had children, they want to know," she told Medscape Medical News. "Just because we catch it doesn't mean we have the treatment to prevent it."
纳拉辛汉博士说，1型糖尿病成人患者都“非常关注”其他家庭成员和后代得该疾病的风险。”她告诉Medscape Medical News：“如果他们打算生孩子或刚有了孩子，他们也想知道的，因为仅仅是我们对疾病有所了解，并不意味着我们有办法治疗或预防它。”
19、Still, screening has other benefits, said Dr. Kakaria. "Patients can potentially enroll in a clinical trial if they choose, they can have the blood tests done serially, and could be followed by a pediatric endocrinologist if they choose."
不过，参加筛选有其他好处，kakaria博士说：“如果他们愿意参加，患者有可能参加一个临床试验，如果他们愿意患者将进行一系列血液测试，并由儿科内分泌家密切观察注意。”
据这方面的先驱发表在美国临床内分泌医师协会第二十一届年会临床讨论会的研究报告，保护β细胞分子不破坏的药物的研究很可能是阻止自身免疫性1型糖尿病进展的下一个步骤。
2、"Most of the trials we do in are in recent-onset type 1 diabetes, when there are plenty of beta cells left — probably at least 20%.... If one could preserve them, it would be much easier to control patients; it's like the honeymoon phase," said George Eisenbarth, MD, PhD, executive director of the Barbara Davis Center for Childhood Diabetes and professor of pediatrics, medicine, and immunology at the University of Colorado at Denver School of Medicine.
科罗拉多大学丹佛医学院分校医学免疫学家、巴巴拉戴维斯中心儿童糖尿病执行主任和儿科教授、医学博士乔治·艾森巴特说：“我们做的大部分的实验是取材于近期发生的1型糖尿病，有大量的β细胞（可能至少20%）存活，如果能维持它们，那控制患者的血糖将非常容易，像是处于糖尿病蜜月期。”
3、Today, autoantibody testing can predict an individual's risk of developing autoimmune type 1 diabetes, and even the age of onset of the disorder — information that could one day guide the use of such preventive therapy, said Dr. Eisenbarth.
艾森巴尔斯博士说：“当代抗体测试可以预测一个人发展成自身免疫性1型糖尿病的风险，甚至疾病出现的年龄，这将指导未来某一天预防性治疗自身免疫性1型糖尿病。”
4、Such testing in random cadaveric donors suggests that half a million people in the United States might be in the early stages of developing type 1 diabetes, Dr. Eisenbarth wrote in a recent paper (Endocr Pract. Published online May 1, 2012), underscoring the urgency of finding preventive drugs.
最近艾森巴尔斯博士写的文件（2012年5月1日在线发表，Endocr Pract）表示：在随机尸体捐赠者进行抗体测试表明，一百万美国人中有一半人可能是处于1型糖尿病早期发展阶段，并强调迫切需要寻找预防性药物。
5、Because the development of type 1 diabetes is a slow process, requiring genetic predisposition and a precipitating trigger followed by the gradual development of beta cell loss, prevention is a realistic goal.
因为1型糖尿病是一个需要遗传易感性和β细胞损失积累触发的缓慢发展过程，所以预防是一个现实的目标。
6、People with genetic predispositions can develop type 1 diabetes at any stage in life, he explained. "If one is an identical twin of someone with type 1A diabetes, you're never out of the woods — autoantibodies can appear later in life and full-blown diabetes even later," he said. A second peak in the incidence of the disorder is seen in people 70 to 80 years of age, he added.
有遗传易感性的人在生命任何阶段都有可能发展为1型糖尿病患者，他解释说：“如果同卵双胞胎中一个有1A型糖尿病，另一个也不会幸免，自身抗体晚些出现或甚至更晚出现晚期糖尿病。”疾病发生第二高峰是在70到80岁，他补充说。
7、To date, 4 autoantibodies are implicated in the development of type 1 diabetes: the islet zinc transporter (ZnT8), insulinoma associated antigen, glutamic acid decarboxylases, and insulin autoantibodies.
迄今，4种抗体与1型糖尿病的发展有牵连：胰岛锌转运体（ZnT 8），胰岛素瘤相关抗原，谷氨酸脱羧酶，与胰岛素自身抗体。
8、Commercial assays are available for all 4 autoantibodies, enabling the screening of people with a family history of the disorder.
4种抗体的商业产品是有价值的，能够筛选有家族病史的人。
9、Detection of a single antibody suggests a risk of developing type 1 diabetes of about 5%, compared with 0.3% in the general population. However, in people with 2 or more autoantibodies, the risk is much higher — up to a 90% by the age of 10 in children followed from birth.
检测到单一抗体时表明，发展成1型糖尿病的风险约为5%，相比下总人口中的发病率是0.3%。然而，检测到2个或更多的抗体时，从出生之后到10岁儿童发展成1型糖尿病的风险高达90%。
10、"Not only can we predict risk, now we can also predict the age at which type 1 diabetes will occur," said Dr. Eisenbarth, explaining that there are 2 factors that predict age at onset. "If you combine these 2 parameters, you can explain about a third of the variation in age at which type 1 diabetes develops," he said.
“我们不仅可以预测风险，现在我们也可以预测1型糖尿病的发生的年龄，”艾森巴尔斯博士解释说目前有2个因素可用来预测发病年龄，“如果你把这2个参数结合起来，你可以解释1型糖尿病发展与年龄的大约三分之一变化。”
11、The first factor is the person's age at autoantibody detection; "that makes sense if we think that the autoimmune process begins when that first autoantibody appears," he said. "Overall, the older you are when the first autoantibody appears, the older you are when diabetes occurs."
自身抗体检测的第一个因素是年龄，他说：“如果我们认为自身免疫开始于第一次抗体的出现，是有道理的。总的来说，第一次抗体的出现的年龄越大，糖尿病发生的年龄也就越大。”
12、The second predictive factor is the level of insulin autoantibody at first detection. "This is specific for insulin [autoantibody]," he said. "The levels of none of the other autoantibodies correlated at all with how long it takes to develop type 1 diabetes."
第二预测因素是第一次检测时胰岛素抗体水平。他说：“胰岛素[抗体]检测信息详细，没有其他自身抗体的水平能反应1型糖尿病发展的时间。”
13、Currently, oral insulin (to induce tolerance) and immunosuppressive or immunomodulating drugs have been shown to preserve beta cells and to delay diabetes onset for 6 months to 1 year. However, work by Dr. Eisenbarth's team is directed at more specific therapies that target the trimolecular complex: the interaction of peptides, T-cell receptors, and major histocompatibility complex molecules.
目前，口服胰岛素（诱导耐受）和免疫抑制或免疫调节药物显示出保护β细胞及延缓糖尿病推迟6个月至1年发病的作用。然而，艾森巴尔斯博士的团队工作针对的是更具体的分子复合物治疗：相互作用的多肽，T细胞受体，和主要组织相容性复合分子。
14、"I bet...we're going to be able to — in many different ways — target this trimolecular complex, and hopefully develop a very specific and safe therapy," he said. 'It's unusual to have a disease that we can predict so well, and know the autoimmunity, and not have an immunologic therapy in our armamentarium."
他说：“我打赌……我们会用许多不同的方式——瞄准这个分子复合物，并希望建立一个非常具体和安全的治疗。而有一种我们可以很好预测的疾病，并知道是由自身免疫导致的，而在我们的医疗设备中没有使用免疫疗法——这是不寻常的。”
15、The availability of autoantibody testing for type 1 diabetes autoantibodies is important to practicing clinicians, according to endocrinologists Shivani Narasimhan, MD, and Parul Kakaria, MD, from the Pinnacle Health System in Harrisburg, Pennsylvania, who attended the session.
1型糖尿病自身抗体检测是很重要的临床实践，根据出席会议的内分泌家什瓦尼纳拉辛汉博士和宾夕法尼亚哈里斯堡顶级卫生系统parul kakaria医学博士的观点。
16、Dr. Eisenbarth's lab "will screen family members between the ages of 2 and 45 for autoantibodies; that is very practical to me," said Dr. Narasimhan.
纳拉辛汉博士说：“艾森巴尔斯博士的实验室将筛选年龄介于2到45岁家庭成员的自身抗体，这对于我来说是非常实用的。”
17、Physicians and patients who want to know more can call 1-800-HALT-DM1 (1-800-425-8361) or visit the TrialNet Web site.
想知道更多的医生或患者可拔打打1-800-halt-dm1（1-800-425-8361）或访问 TrialNet Web site。
18、Dr. Narasimhan said that her adult patients with type 1 diabetes are "very much concerned" about the risk of other family members and offspring developing the disease. "If they're planning on having children or have just had children, they want to know," she told Medscape Medical News. "Just because we catch it doesn't mean we have the treatment to prevent it."
纳拉辛汉博士说，1型糖尿病成人患者都“非常关注”其他家庭成员和后代得该疾病的风险。”她告诉Medscape Medical News：“如果他们打算生孩子或刚有了孩子，他们也想知道的，因为仅仅是我们对疾病有所了解，并不意味着我们有办法治疗或预防它。”
19、Still, screening has other benefits, said Dr. Kakaria. "Patients can potentially enroll in a clinical trial if they choose, they can have the blood tests done serially, and could be followed by a pediatric endocrinologist if they choose."
不过，参加筛选有其他好处，kakaria博士说：“如果他们愿意参加，患者有可能参加一个临床试验，如果他们愿意患者将进行一系列血液测试，并由儿科内分泌家密切观察注意。”
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