澳科学家称I型糖尿病患者更易感染肠道病毒

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澳科学家称I型糖尿病患者更易感染肠道病毒

新一期《英国医学杂志》刊登研究报告说，I型糖尿病患者往往更容易感染肠道病毒，但目前还不清楚其背后的因果关系，对此进一步研究将有助于理解糖尿病的发病机理并研发新治疗手段。

澳大利亚新南威尔士大学等机构研究人员报告说，过去对I型糖尿病和肠道病毒感染之间的联系有一些猜测，为确认两者的关系，他们回顾了这方面的大量研究，调查了4000多人的健康资料。结果显示，那些患有I型糖尿病的人，感染肠道病毒的风险是其他人的约10倍。

肠道病毒是一类病毒的总称，包括柯萨奇病毒、脊髓灰质炎病毒等，它们可引起发热和咳嗽等感冒症状，有的还会引发手足口病、脑膜炎或脊髓灰质炎。I型糖尿病又称胰岛素依赖型糖尿病或青少年糖尿病，多发于儿童以及青少年。本次研究中的调查对象大部分是儿童，因此患I型糖尿病的儿童需要注意预防肠道病毒感染。

研究人员说，目前只是发现了一种相关性，还不能确定I型糖尿病和肠道病毒感染的因果关系，或是有第三种因素，如可能有某种基因缺陷使人既易患I型糖尿病又易被肠道病毒感染。

但这种相关性为研究I型糖尿病的病因提供了一个突破口。目前人们知道基因对I型糖尿病发病起着重要作用，但还不能完全解释这种疾病，如能在本次研究基础上进一步理解I型糖尿病的发病机理，将有助于研发新的治疗手段。

Enterovirus infection and type 1 diabetes mellitus: systematic review and meta-analysis of observational molecular studies
Abstract
Objective To review the association between current enterovirus infection diagnosed with molecular testing and development of autoimmunity or type 1 diabetes.

Design Systematic review and meta-analysis of observational studies, analysed with random effects models.

Data sources PubMed (until May 2010) and Embase (until May 2010), no language restrictions, studies in humans only; reference lists of identified articles; and contact with authors.

Study eligibility criteria Cohort or case-control studies measuring enterovirus RNA or viral protein in blood, stool, or tissue of patients with pre-diabetes and diabetes, with adequate data to calculate an odds ratio and 95% confidence intervals.

Results The 24 papers and two abstracts (all case-control studies) that met the eligibility criteria included 4448 participants. Study design varied greatly, with a high level of statistical heterogeneity. The two separate outcomes were diabetes related autoimmunity or type 1 diabetes. Meta-analysis showed a significant association between enterovirus infection and type 1 diabetes related autoimmunity (odds ratio 3.7, 95% confidence interval 2.1 to 6.8; heterogeneity χ2/df=1.3) and clinical type 1 diabetes (9.8, 5.5 to 17.4; χ2/df=3.2).

Conclusions There is a clinically significant association between enterovirus infection, detected with molecular methods, and autoimmunity/type 1 diabetes. Larger prospective studies would be needed to establish a clear temporal relation between enterovirus infection and the development of autoimmunity and type 1 diabetes.