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目的探讨特发性1型糖尿病(1B 型糖尿病)患者是否存在胰岛自身抗原反应性 T 细胞。方法选择经典1型糖尿病(1A 型糖尿病)患者23例,1B 型糖尿病29例,健康对照16例;放射配体法检测胰岛自身抗体;连续密度梯度离心法分离人外周血单个核细胞;酶联免疫斑点法(ELISPOT)检测谷氨酸脱羧酶(GAD_(65))反应性、分泌γ干扰素(IFN-γ)的 T 细胞(IFN-γ-T 细胞)。结果 (1)IFN-γ-T 细胞数(中位数及95%CI 表示)1A 型糖尿病为:12.0个(10.3～20.9个),1B 型糖尿病:3.5个(3.0～5.7个),对照:1.0个(0.3～1.8个)。1A 型糖尿病的 IFN-γ-T 细胞数明显高于1B 型糖尿病及对照(均 P<0.01)。1B 型糖尿病较对照具有更高频率的 IFN-γ-T 细胞(P<0.05)。(2)以>95%CI(对照组)判为 IFN-γ-T 阳性,1A 型糖尿病、1B 型糖尿病及对照的阳性率分别为:78.3%(18/23)、48.3%(14/29)及0。(3)3组对植物血凝素非特异性刺激的 IFN-γ-T 细胞数差异无统计学意义(P>0.05)。结论部分1B 型糖尿病患者存在 GAD_(65)反应性 IFN-γ-T 细胞,即存在 T 细胞免疫异常,具有与1A 型糖尿病相似的病因及发病机制;诊断1B 型糖尿病前应排除 IFN-γ-T 阳性患者,GAD_(65)-IFN-γ-T 检测有望成为糖尿病分型诊断的新指标。
Objective To investigate the presence of islet autoantigen-reactive T cells in patients with idiopathic type 1 diabetes mellitus (type 1B diabetes mellitus). Methods Twenty-three patients with classic type 1 diabetes mellitus (type 1 diabetes mellitus), 29 type 1 diabetes mellitus (T2DM) and 16 healthy controls were selected. Radioligand was used to detect islet autoantibodies. Human peripheral blood mononuclear cells were isolated by continuous density gradient centrifugation. Immunocytometry (ELISPOT) was used to detect the activity of glutamic acid decarboxylase (GAD_ (65)) and IFN-γ secreting T cells (IFN-γ-T cells). Results (1) The number of IFN-γ-T cells (median and 95% CI) were 12.0 (10.3-20.9) for type 1A diabetes and 3.5 (3.0-5.7) for type 1B diabetes. 1.0 (0.3 ~ 1.8). The number of IFN-γ-T cells in type 1A diabetes was significantly higher than that in type 1B diabetes and controls (all P <0.01). Type 1 diabetes had higher frequency of IFN-γ-T cells (P <0.05) than controls. (2) The positive rate of IFN-γ-T was> 95% CI (control group). The positive rates of type 1 diabetes, type 1 diabetes and control were 78.3% (18/23) and 48.3% (14/29 ) And 0. (3) There was no significant difference in the number of IFN-γ-T cells stimulated by phytohemagglutinin in the three groups (P> 0.05). CONCLUSIONS: Some patients with type 1 diabetes have GAD (65) reactive IFN-γ-T cells, which have T cell immune abnormalities and have similar etiology and pathogenesis as type 1A diabetes. IFN-γ- T positive patients, GAD_ (65) -IFN-γ-T test is expected to become a new diagnostic indicator of diabetes.