近日，德国环境健康研究中心Peter Achenbach及其研究组分析了德国巴伐利亚州儿童胰岛自身抗体的公共健康筛查结果。相关论文于2020年1月28日发表在《美国医学会杂志》上。

在症状前阶段对1型糖尿病进行公共卫生筛查，可降低疾病的严重程度和人群负担。

为了确定参加胰岛自身抗体公共健康筛查项目的儿童中症状前1型糖尿病的患病率，并评估进展为糖尿病的风险，2015-2019年，德国巴伐利亚州的初级保健儿科医生在幼儿体检期间为1.75-5.99岁的儿童进行了胰岛自身抗体筛查。症状前1型糖尿病由2种及以上胰岛自身抗体定义，分为1期（血糖正常）、2期（血糖异常）或3期（临床症状）。

经筛查，90632名儿童的平均年龄为3.1岁，女孩占48.5%，共有280名患有症状前1型糖尿病，其中196名（0.22%）为1期，17名（0.02%）为2期，26名（0.03%）为3期，还有41名患儿未分期。

中位随访2.4年后，又有36名儿童发生3期1型糖尿病。有2名儿童患糖尿病酮症酸中毒。与没有胰岛自身抗体儿童的母亲相比，症状前1型糖尿病儿童的母亲在得知代谢分期时的中位心理压力值显著升高，但在随访12个月后有所下降。

总之，德国巴伐利亚州2-5岁儿童胰岛自身抗体阳性率为0.31%。该发现可为基于人群的儿童胰岛素自身抗体筛查提供参考。

附：英文原文

Title: Yield of a Public Health Screening of Children for Islet Autoantibodies in Bavaria, Germany

Author: Anette-Gabriele Ziegler, Kerstin Kick, Ezio Bonifacio, Florian Haupt, Markus Hippich, Desiree Dunstheimer, Martin Lang, Otto Laub, Katharina Warncke, Karin Lange, Robin Assfalg, Manja Jolink, Christiane Winkler, Peter Achenbach

Issue&Volume: 2020/01/28

Abstract:

Importance  Public health screening for type 1 diabetes in its presymptomatic stages may reduce disease severity and burden on a population level.

Objective  To determine the prevalence of presymptomatic type 1 diabetes in children participating in a public health screening program for islet autoantibodies and the risk for progression to clinical diabetes.

Design, Setting, and Participants  Screening for islet autoantibodies was offered to children aged 1.75 to 5.99 years in Bavaria, Germany, between 2015 and 2019 by primary care pediatricians during well-baby visits. Families of children with multiple islet autoantibodies (presymptomatic type 1 diabetes) were invited to participate in a program of diabetes education, metabolic staging, assessment of psychological stress associated with diagnosis, and prospective follow-up for progression to clinical diabetes until July 31, 2019.

Exposures  Measurement of islet autoantibodies.

Main Outcomes and Measures  The primary outcome was presymptomatic type 1 diabetes, defined by 2 or more islet autoantibodies, with categorization into stages 1 (normoglycemia), 2 (dysglycemia), or 3 (clinical) type 1 diabetes. Secondary outcomes were the frequency of diabetic ketoacidosis and parental psychological stress, assessed by the Patient Health Questionnaire-9 (range, 0-27; higher scores indicate worse depression; ≤4 indicates no to minimal depression; >20 indicates severe depression).

Results  Of 90?632 children screened (median [interquartile range {IQR}] age, 3.1 [2.1-4.2] years; 48.5% girls), 280 (0.31%; 95% CI, 0.27-0.35) had presymptomatic type 1 diabetes, including 196 (0.22%) with stage 1, 17 (0.02%) with stage 2, 26 (0.03%) with stage 3, and 41 who were not staged. After a median (IQR) follow-up of 2.4 (1.0-3.2) years, another 36 children developed stage 3 type 1 diabetes. The 3-year cumulative risk for stage 3 type 1 diabetes in the 280 children with presymptomatic type 1 diabetes was 24.9% ([95% CI, 18.5%-30.7%]; 54 cases; annualized rate, 9.0%). Two children had diabetic ketoacidosis. Median (IQR) psychological stress scores were significantly increased at the time of metabolic staging in mothers of children with presymptomatic type 1 diabetes (3 [1-7]) compared with mothers of children without islet autoantibodies (2 [1-4]) (P=.002), but declined after 12 months of follow-up (2 [0-4]) (P<.001).

Conclusions and Relevance  Among children aged 2 to 5 years in Bavaria, Germany, a program of primary care–based screening showed an islet autoantibody prevalence of 0.31%. These findings may inform considerations of population-based screening of children for islet autoantibodies.

DOI: 10.1001/jama.2019.21565

Source: https://jamanetwork.com/journals/jama/article-abstract/2759473