Abstract
Objective To investigate the correlation between juvenile lupus erythematosus and type 1 diabetes mellitus and pancreatic injuries. Methods In this prospective study, 74 children with system lupus erythematosus (SLE), 5 cases with neonatal lupus erythematosus (NLE) admitted in Department of Rheumatism and Immunology of Children's Hospital Affiliated to Capital Institute of Pediatrics from March 2007 to March 2015 and 30 healthy children as normal controls were enrolled. Islet cell antibodies (ICA), insulin autoantibodies (IAA) and glutamic acid decarboxylase antibodies (GADA) of each subject were detected by enzyme-linked immunosorbent assay (ELISA), random blood glucose and fasting blood glucose by hexokinase method as well as glycosylated hemoglobin by high performance liquid chromatography. Detailed monitoring of the symptoms, signs and autoantibodies were recorded. Carbohydrate tolerance test arranged for some patients and three kinds of antibodies above were detected during the recovery period. χ2 test was used to test the relativity between activities of disease and autoantibodies including ICA, IAA and GADA in the children with lupus erythematosus. Results Among 74 children with systemic lupus erythematosus, 2 cases were found the fasting blood glucose 6.5%. All the 6 cases were transitional hyperglycemia with random blood sugar>11.1 mmol/L. The glucose tolerance test of the 6 patients above were normal, which could exclude the diagnose of diabetes mellitus. One of 74 patients was positive ICA. For IAA, 24 patients were positive and 21 cases with positive GADA were detected. In all 74 patients, there were 36 cases with one positive antibody while 9 cases with positive IAA and GADA simultaneously. In 5 children with NLE, 2 cases were found with positive IAA and GADA simultaneously, 1 case with positive IAA only and 2 cases with all 3 antibodies negative. There was a statistically significant difference between SLE, NLE and the normal group in ICA, IAA, GADA positive rate (P<0.001). The positive rates of ICA, IAA and GADA were 1.35%(1/74), 32.43%(24/74) and 28.38%(21/74)in SLE group; the positive rates of ICA, IAA, GADA were 0, 3/5 and 2/5 in NLE group; the positive rates of ICA, IAA and GADA were 0, 0 and 3.33%(1/30)in the control group (ICA: χ2=12.649, P<0.001; GADA: χ2=8.028, P=0.005). Of 8 cases with positive antibodies who received tests of their positive antibodies during the periods of recovery, 6 cases were detected with positive IAA, of whom 4 turned negative. In 5 cases with positive GADA, 4 turned negative. Only 1 in 30 healthy children of the normal control was found with GADA positive. Conclusions Relatively high rates of positive diabetes mellitus related antibodies were detected in current study. Diabetes mellitus related antibodies could be detected in children with SLE and even in neonates with lupus erythematosus. Blood glucose should be tested and monitored to detect the possibility of concomitant type 1 diabetes mellitus in children with SLE.(Chin J Lab Med, 2016, 39: 829-832) Key words: Lupus erythematosus, systemic; Insuli antibodies; Autoantibodies; Glutamate decarboxylase; Blood glucose
Published Version
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