췌장 자가 항체 유무에 따른 제 1형 당뇨병의 임상 및 검사 소견의 비교 = Comparison of clinical and laboratory characteristics in children with type 1 diabetes according to pancreatic autoantibodies

다국어 초록 (Multilingual Abstract)

Purpose:The purpose of this study was to determine whether there is any difference in the clinical and laboratory characteristics of patients with autoantibody-positive and patients with autoantibody-negative type 1 diabetes at initial presentation.
Methods:We analyzed 96 patients under 18 years of age with newly diagnosed type 1 diabetes. One or both of the pancreatic autoantibodies-glutamic acid decarboxylase autoantibodies (GADA) and insulin autoantibody (IAA)-were measured in all patients, and we reviewed clinical and laboratory characteristics according to the presence of these autoantibodies.
Results:GADA was examined in 48 of 87 patients, and 55.2% of patients were positive. IAA was checked in 88 patients, and 39.8% were positive. Both GADA and IAA were measured in 83 patients, and 22.8% had both antibodies. The patients who had one or both autoantibodies (autoantibody-positive group) were younger than those not having any autoantibody (autoantibody-negative group). The autoantibody-positive group had lower BMI, corrected sodium level, and serum effective osmolarity, compared to the autoantibody-negative group (P<0.05). Similar differences were found between the GADA-positive and GADA-negative groups. However, there were no significant differences between the IAA- positive and IAA-negative groups.
Conclusion:The prevalence of pancreatic autoantibodies was significantly higher in the under-6 years age group than in the other age groups. These findings suggest that measurement of autoantibodies at the initial diagnosis of diabetes is very useful for detecting immune-mediated type 1 diabetes and providing intensive insulin therapy, especially in younger children.

국문 초록 (Abstract)

목적:제 1형 당뇨병에서 보이는 자가 항체와 질환의 진행에 따른 변화와의 관계는 여러 연구에서 보고되었고, 항체가가 높을수록 진행의 정도가 급격하였다. 따라서 진단 당시에 시행한 자가 항체의 발현 여부에 따라 임상 발현 정도가 다를 것으로 생각하여, 자가 항체 유무에 따라 임상 양상과 검사 소견의 차이가 있는지를 확인하고자 하였다.
방법:1999년 4월부터 2008년 3월까지 3개 대학병원에 내원하여 제 1형 당뇨병으로 진단받은 18세 미만 환자 중 처음 진단 당시에 췌장 자가 항체인 GADA 혹은 IAA의 검사를 시행하였던 96명에서 진단 당시 시행한 혈액 검사 및 임상 양상을 항체 그룹에 따라 나누어 비교 분석하였다.
결과:GADA는 87명의 환자에서 검사가 이루어 졌고, 이 중 48명(55.2%)에서 양성을 보였다. IAA는 88명 중 35명(39.8%) 이 양성을 보였다. 두가지 항체를 모두 검사한 환자는 83명이었고, 이 중 22.8%에서 두 항체가 모두 검출되었고, 38.6%에서는 모두 음성을 보였다. 1가지 이상의 항체를 갖는 환자군에서는 음성군에 비해 비교적 어린 나이에 당뇨병이 발생하였고, 낮은 BMI, 낮은 혈청 교정 Na 수치 및 낮은 혈청 오스몰농도를 보였다(P<0.05). 자가 항체 중 GADA 양성군과 음성군 사이의 검사소견 상에서도 같은 차이를 보였다. 그러나 IAA 항체 유무에 따른 비교에서는 발생 연령이외는 두 군사이에 임상 및 검사소견상 유의한 차이를 볼 수 없었다.
결론:항체 양성군과 음성군 사이에서 보이는 대사적 결과의 차이는 비교적 적었으나 GADA와 IAA 항체의 양성율은 어린 연령에서 높았다. 따라서 비교적 어린 연령에 발생하는 1형 당뇨병에서는 질환을 처음으로 진단할 때자가 항체 유무를 확인하고, 만약 항체가 확인되면 향후 집중적인 인슐린 치료를 시행하여 보다 좋은 예후를 유도하는데 도움이 될 수 있을 것이다.

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