摘要
目的探讨成人迟发性自身免疫性糖尿病(LADA)的临床特征,以探究在初始表现为2型糖尿病(T2DM)的中老年患者中筛查LADA的临床线索。方法比较2000年1月—2007年12月在上海交通大学附属第六人民医院内分泌代谢科住院的45岁以上、谷氨酸脱羧酶抗体(GADA)阳性的110例LADA患者(LADA组)与同期住院的240例GADA阴性的T2DM患者(T2DM组)的临床特征、胰岛功能(空腹C肽水平、餐后与基础C肽差值等生化指标)以及肾病、眼病等微血管病变的发生率。结果LADA组的体质指数(BMI)、空腹C肽、餐后30minC肽、餐后2hC肽以及餐后2hC肽与空腹C肽差值(ΔC肽)均显著低于T2DM组(P值均<0.01),HbA1c则显著高于T2DM组(P<0.05)。BMI≤23kg/m2时,预测LADA的敏感性为70%,特异性为67%,Youden指数为0.37;ΔC肽≤0.85μg/L时,预测LADA的敏感性为72%,特异性为74%,Youden指数为0.45。结论对初诊为T2DM的中老年患者,低BMI、低空腹C肽水平和低ΔC肽是筛查LADA的重要临床线索,确诊LADA需测定胰岛自身抗体,GADA滴度高者的胰岛功能较滴度低者更差。
Objective To study the clinical features of latent autoimmune diabetes mellitus in adults （LADA） ,and to search for clinical clues to identify LADA from type 2 diabetes in an earlier period. Methods A total of 110 LADA patients with positive serum autoantibodies against glutamate decarboxylase （GADA） or tyrosine phosphatase （IA2-Ab） were included in the present study; and their clinical characteristics, pancreatic functions （fasting, postprandial and basal C peptide）, nephropathy, retinopathy, etc. were compared with those of 240 patients with type 2 diabetes mellitus （T2DM）negative of GADA. Results The body mass index, fasting C-peptide（FCP） ,30 min, 120 min postprandial C-peptide, and the margin between postprandial two hours and fasting C-peptide（△C-p）in LADA group were significantly lower than those in the T2DM group （all P〈0.01） ; and HbA1 c was significantly higher than that in T2DM group（P〈0.05）. When BMI≤23 kg/m^2 , the sensitivity for predicting LADA was 700%, the specificity was 67 %, and the Youden index was 0.37; when △C-p≤0.85μg/L, the sensitivity for predicting LADA was 72%, specificity was 74%, and the Youden index was 0.45. Conclusion Low BMI and C-peptide are important clinical clues for identifying LADA from type 2 diabetic patients; a confirmed diagnosis of LADA relies on examination of the autoantibodies against islet β cells. The patients who have high titer of GADA have lower C-peptide secretion.
出处
《上海医学》
CAS
CSCD
北大核心
2008年第11期774-777,共4页
Shanghai Medical Journal
关键词
临床特征
成年人迟发性自身免疫性糖尿病
谷氨酸脱羧酶抗体
Clinical feature, Latent autoimmune diabetes mellitus in adults
Glutamic acid decarboxylase autoantibody
