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発症時に複数の膵島関連自己抗体の同時出現を認めた急性発症1型糖尿病の1例


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Title: 発症時に複数の膵島関連自己抗体の同時出現を認めた急性発症1型糖尿病の1例
Other Titles: Simultaneous Emergence of Multiple Islet-associated Autoantibodies in a Patient with Acute-onset Type 1 Diabetes
Authors: 安井, 順一 / 川﨑, 英二 / 原口, 愛 / 池岡, 俊幸 / 植木, 郁子 / 赤澤, 諭 / 堀江, 一郎 / 古林, 正和 / 阿比留, 教生 / 山崎, 浩則 / 川上, 純
Authors (alternative): Yasui, Junichi / Kawasaki, Eiji / Haraguchi, Ai / Ikeoka, Toshiyuki / Ueki, Ikuko / Akazawa, Satoru / Horie, Ichiro / Kobayashi, Masakazu / Abiru, Norio / Yamasaki, Hironori / Kawakami, Atsushi
Issue Date: 11-Mar-2014
Publisher: 日本糖尿病学会 / Japan Diabetes Society
Citation: 糖尿病, 57(2), pp.108-112; 2014
Abstract: 症例は61歳,女性.54歳時に口渇,体重減少が出現し,近医で随時血糖値598 mg/dl,HbA1c 14.2 %,尿ケトン体陽性,尿中CPR 28 μg/日にて糖尿病性ケトーシスの診断のもとインスリン療法が開始された.56歳時に血糖コントロール目的で再入院した際,GAD抗体陽性(337.4 U/ml)が判明し,1A型糖尿病と診断された.内因性インスリン分泌能は枯渇しブリットル型糖尿病を呈していたため,当院紹介入院となった.経時保存血清を用いて膵島関連自己抗体の出現様式を検討したところ,1型糖尿病発症時にGAD抗体,IA-2抗体,ZnT8抗体が同時に出現しており,GAD抗体はその後も持続陽性を呈するもIA-2抗体,ZnT8抗体は発症1~3年後には陰性化していた.一般的には順次出現する膵島関連自己抗体の複数同時出現を確認できた症例は非常に稀であり文献的考察を加え報告する. / A 61-year-old woman had been diagnosed with diabetic ketosis at 54 years of age due to hyperglycemia (plasma glucose: 598 mg/dl, HbA1c: 14.2 %) and the presence of urinary ketones. She was admitted to a hospital, and insulin therapy was initiated based on her low endogenous insulin secretion (urinary CPR: 28 μg/day). She was admitted to the same hospital again at 56 years of age for glycemic control, at which time, she was diagnosed with type 1A diabetes due to positive GAD antibodies (337.4 U/ml). Her blood glucose level was uncontrollable as a result of exhausted endogenous insulin secretion, and she was referred to our hospital. We examined the emergence pattern of islet-associated autoantibodies using the patient's stored serum samples. Consequently, the simultaneous emergence of autoantibodies to GAD, IA-2, and ZnT8 was detected at the onset of type 1 diabetes. Although GAD antibodies were persistently positive, autoantibodies to IA-2 and ZnT8 became negative within three years after disease onset. The emergence of islet-associated autoantibodies generally occurs before the clinical development of type 1 diabetes. We herein demonstrated a rare case of type 1 diabetes in which islet-associated autoantibodies developed simultaneously, not sequentially.
Keywords: 1型糖尿病 / 膵島関連自己抗体 / HLA / 自己免疫性甲状腺疾患
URI: http://hdl.handle.net/10069/34445
ISSN: 0021437X
DOI: 10.11213/tonyobyo.57.108
Rights: © 2014 一般社団法人 日本糖尿病学会 / 利用は著作権の範囲内に限られる
Type: Journal Article
Text Version: author
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/34445

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