Pancreatic Pathology in Type 1 (Insulin-Dependent) Diabetes Mellitus

Medicine, Pathology

Foulis, Alan Keith

University:University of Glasgow

关键词: Medicine, Pathology;   

Others  :  http://theses.gla.ac.uk/77534/1/10995582.pdf

来源: University of Glasgow

【 摘 要 】

While the serum and leucocytes of diabetics have been studied exhaustively in attempts to elucidate the pathogenesis of type 1 (insulin-dependent) diabetes, the pancreas, the stage on which the drama of B cell death is played, has been largely ignored. In an attempt to partially correct this, a 25 year computerised survey of deaths in the United Kingdom among diabetics under the age of 30 years was performed. Suitable pancreatic material was available in 155 cases. The disease was known to have been present for less than a year in 74. Insulitis (a chronic inflammatory cell infiltrate affecting islets) was present in 59 of these 74 cases (80%). Insulitis affected 20% of islets containing insulin but only 1% of islets which were insulin deficient. This observation has provided the most substantial direct evidence that insulitis represents an immunologically mediated destruction of B cells. The fact that insulitis could be found up to 6 years after presentation showed that destruction of B cells may take place over a prolonged period of time. Several unusual cases of diabetes were found which highlighted the heterogeneity of the disease. In the most interesting of these there seemed to have been massive simultaneous necrosis of B cells, suggesting an acute viral cytopathic effect.