Prävalenz und Bedeutung der diabetes-spezifischen Autoantikörper GADA, IA-2A und IAA zum Zeitpunkt der Manifestation eines Typ-1-Diabetes bei 341 Kindern und Jugendlichen

Zusammenfassung

Ziel dieser Arbeit war die Charakterisierung eines großen Patientenkollektivs von Kindern und Jugendlichen mit Typ-1-Diabetes (T1D) in Deutschland hinsichtlich der Prävalenz einzelner und multipler Diabetes-spezifischer Autoantikörper zum Zeitpunkt der Manifestation der Erkrankung. 341 Kinder und Jugendliche (53,1 % Knaben) mit T1D-Manifestation im Alter von 8,9 ± 4,2 Jahren (Bereich 0-17 Jahre) nahmen im Zeitraum von 1989 bis 2004 an dieser Auswertung teil. Die T1D-spezifischen Autoantikörper GADA, IA-2A und IAA wurden mittels Radioimmunoassay (Medipan, Berlin-Dahlewitz, Deutschland) innerhalb der ersten 12 Wochen nach T1D-Manifestation bestimmt. 73 % der Patienten waren positiv für IA-2A, 72 % für GADA und 46 % für IAA. Die überwiegende Mehrheit der Patienten (92 %) hatte mindestens einen erhöhten T1D-spezifischen Autoantikörper, während nur 8 % keine Autoantikörper aufwiesen. Knaben sowie jüngere Kinder waren für IAA signifikant häufiger positiv als Mädchen (p < 0,01) bzw. ältere Kinder (p < 0,05). GADA-positive Patienten waren bei T1D-Manifestation älter als GADA-negative Patienten (p < 0,001). Insgesamt waren 80 % der über 12-Jährigen positiv für GADA, während dies nur bei 57 % der unter 6-Jährigen der Fall war (p < 0,001). Diese Ergebnisse zeigen, dass bei mehr als 90 % der Patienten mit Typ-1-Diabetes diabetes-spezifische Autoantikörper bereits zum Zeitpunkt der Manifestation nachweisbar sind. Somit ist die T1D-AAK-Bestimmung weiterhin eine wichtige diagnostische Untersuchung, um den Typ-1-Diabetes frühzeitig zu erkennen und ihn von anderen Diabetesformen im Kindes- und Jugendalter abzugrenzen.

Abstract

Aim of this study was to assess the prevalence of diabetes-specific autoantibodies in a large German cohort of children and adolescents at the time of diagnosis of type 1 diabetes (T1D). A total of 341 patients (53.1 % male) diagnosed with T1D between 1989 and 2004 (mean age 8.9 ± 4.2 years, range 0-17 years) participated in the study. The T1D-specific autoantibodies GADA, IA-2A and IAA were determined by radioimmunoassay (Medipan, Berlin-Dahlewitz, Germany) within twelve weeks from T1D onset. 73 % of patients were positive for IA-2A, 72 % for GADA and 46 % for IAA. The vast majority of patients (92 %) had at least one antibody, while 8 % were negative for all three antibodies. Boys and younger children were more frequently positive for IAA than girls (p < 0.01) or older children (p < 0.05), respectively. GADA positive patients were older at T1D onset than those without GADA (p < 0.001). These results indicate that more than 90 % of young patients with T1D are positive for diabetes-specific antibodies at the time of clinical diagnosis of the disease. Thus, determination of these antibodies is an important tool for an early diagnosis and differentiation of type 1 diabetes from other diabetes forms in childhood and adolescence.

Schlüsselwörter

Typ-1-Diabetes - Kinder - Jugendliche - GADA - IAA - IA-2A - Altersunterschiede

Key words

type 1 diabetes - GADA - IAA - IA-2A - children - adolescents - age differences

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