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Etiopathogenesis of type 1 diabetes mellitus: prognostic factors for the evolution of residual β cell function

机译:1型糖尿病的病因:残余β细胞功能演变的预后因素

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摘要

Type 1A diabetes mellitus (T1ADM) is a progressive autoimmune disease mediated by T lymphocytes with destruction of beta cells. Up to now, we do not have precise methods to assess the beta cell mass, "in vivo" or "ex-vivo". The studies about its genetic susceptibility show strong association with class II antigens of the HLA system (particularly DQ). Others genetics associations are weaker and depend on the population studied. A combination of precipitating events may occur at the beginning of the disease. There is a silent loss of immune-mediated beta cells mass which velocity has an inverse relation with the age, but it is influenced by genetic and metabolic factors. We can predict the development of the disease primarily through the determination of four biochemically islet auto antibodies against antigens like insulin, GAD65, IA2 and Znt8. Beta cell destruction is chronically progressive but at clinical diagnosis of the disease a reserve of these cells still functioning. The goal of secondary disease prevention is halt the autoimmune attack on beta cells by redirecting or dampening the immune system. It is remains one of the foremost therapeutic goals in the T1ADM. Glycemic intensive control and immunotherapeutic agents may preserve beta-cell function in newly diagnosed patients with T1ADM. It may be assessed through C-peptide values, which are important for glycemic stability and for the prevention of chronic complications of this disease. This article will summarize the etiopathogenesis mechanisms of this disease and the factors can influence on residual C-peptide and the strategies to it preservation.
机译:1A型糖尿病(T1ADM)是由T淋巴细胞介导的β细胞破坏引起的进行性自身免疫疾病。到目前为止,我们还没有精确的方法来评估“体内”或“离体”β细胞的质量。关于其遗传易感性的研究显示与HLA系统的II类抗原(尤其是DQ)有很强的联系。其他的遗传学关联较弱,并且取决于所研究的人群。在疾病开始时可能会发生一系列沉淀事件。免疫介导的β细胞团大量消失,速度与年龄成反比,但受遗传和代谢因素影响。我们可以主要通过确定四种针对抗原(如胰岛素,GAD65,IA2和Znt8)的生化胰岛自身抗体来预测疾病的发展。 β细胞破坏是长期进行的,但在疾病的临床诊断中,这些细胞的储备仍在起作用。二级疾病预防的目标是通过重定向或削弱免疫系统来阻止对β细胞的自身免疫攻击。它仍然是T1ADM中最重要的治疗目标之一。血糖强化控制和免疫治疗剂可以在新诊断的T1ADM患者中保留β细胞功能。可以通过C肽值进行评估,这对于血糖稳定性和预防该疾病的慢性并发症很重要。本文将总结这种疾病的病因发病机制,以及影响残留C肽的因素及其保存策略。

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