[Immunological features of fulminant type 1 diabetes].

OBJECTIVE: To investigate the immunological features of fulminant type 1 diabetes. METHODS: Twenty patients with fulminant type 1 diabetes (F1D) were recruited based upon the criteria proposed by Hanafusa, and 40 patients with classical type 1 diabetes were matched with age, gender and duration for comparison. GADA, IA2A and ZnT8A were determined with radioligand assay, and GAD-reactive T cells were measured by enzyme-linked immunospot (ELISPOT) assay. The HLA-DQ were analyzed by sequence-based genotyping (SBT). RESULTS: Eight of 20 patients with F1D were antibody-positive, including 7 GADA positive, 4 ZnT8A positive, and 3 both GADA and ZnT8A positive. The index of 3 GADA positive patients were less than 0.4 at first visit, two turned to be negative by two or three years. While the GADA index of the patient was 0.343 at onset and increased to 1.467 three years later. Among subjects with F1D (3/6) and classical type 1 diabetes (3/6), were recorded significant GAD-stimulated responses by ELISPOT assay. The frequencies of HLA-DQA1*0102-DQB1*0601 and DQA1*03-DQB1*0401 were significantly higher in F1D than those in classical type 1 diabetes (P = 0.005, P = 0.035, respectively). CONCLUSION: Humoral and cellular immunoreactivity and susceptible HLA-DQ genotype existed in part of F1D patients, indicating autoimmunity may involve in the pathogenesis of F1D.

[Non-alcoholic fatty liver, high sensitivity C reactive protein and insulin resistance].

OBJECTIVE: To explore the relationship among non-acoholic fatty liver disease (NAFLD), high sensitivity reactive C protein (hsCRP) and insulin resistance. METHODS: Workers of an enterprise in Changsha for health examination in Second Xiangya Hospital from October to December, 2006, NAFLD group (243 patients) and a control group without fatty liver disease (361 patients) were randomly drawn. Questionnaire, physical examination, fasting plasma glucose, serum lipid-profile, alanine aminotransferase (ALT),blood uric acid, and abdominal ultrasonographic examination were undertaken in the 2 groups. RESULTS: The moderate NAFLD group had significantly higher hsCRP concentration and homeostasis model assessment of insulin resistance (HOMA-IR) as compared with the mild NAFLD group (P<0.01). The patients with insulin resistance had significantly higher hsCRP concentration and ALT level compared with NAFLD patients without insulin resistance (P<0.05). The NAFLD patients were divided into 2 groups (low and high) according to the hsCRP concentration (<1 mg/L or > or = 1 mg/L). Compared with the low concentration group, the odds ratio of the high concentration group for prevalence of NAFLD was 5.937(P<0.001). Multi-factor logistic regression analysis demonstrated that NAFLD was independently correlated with hsCRP or HOMA-IR after adjustment for sex, age and metabolic components (OR=2.044, 7.896,P<0.01). CONCLUSION: NAFLD is closely correlated with hsCRP and HOMA-IR. Insulin resistance and elevated hsCRP concentration are the independent risk factors for the presence of NAFLD.