1型糖尿病的免疫防治

Immunotherapy for the prevention and treatment of type 1 diabetes mellitus

1型糖尿病（T1DM）是遗传与环境因素共同作用所致的自身免疫性疾病。为预防和延缓T1DM高危人群自身免疫性胰岛炎的发生，阻止新发T1DM残存胰岛B细胞进一步遭受免疫破坏，T1DM的免疫防治有了较大进展。根据干预实施时机的不同，分为一级、二级和三级预防。主要通过饮食干预、自身抗原疫苗接种及单克隆抗体治疗等措施诱导自身免疫耐受，改善免疫调节，减少胰岛B细胞凋亡。许多临床研究对T1DM的免疫干预进行了探索，并进行了谷氨酸脱羧酶（GAD）疫苗、抗CD3单克隆抗体、DiaPep277等药物的临床研究，为T1DM的防治提供了新启示。

Type 1 diabetes mellitus（T1 DM）is an autoimmune disease attributed to both genetic and environmental factors. To prevent and delay autoimmune insulitis in population with high risk of T1 DM, as well as to protect β cells from autoimmune destruction in recent-onset T1DM, the immunotherapy for the pre- vention and treatment of T1DM has made a great progress. Three stages of intervention according to different situation are involved, which are primary, secondary and tertiary prevention. Treatment strategies aim to in- duce autoimmune tolerance, improve immune regulation and reduce β cells apoptosis through measures such as dietary intervention, self-antigen vaccine injection and monoclonal antibody therapy. Numbers of clinical trials explored the efficacy of immuno-intervention for T1 DM, and evaluated glutamic acid decarboxylase （GAD） vaccine, anti-CD3 monoclonal antibody and DiaPep277 therapy provide new promise for the treatment and prevention of T1DM.