摘要
目的分析初诊2型糖尿病(T2DM)患者中成人隐匿性自身免疫糖尿病(LADA)的临床特征,探讨据此是否可以建立LADA诊断模型。方法分析2016年5月至2017年1月岳阳市中心医院代谢内分泌科门诊及住院的新诊断T2DM患者302例,均完善谷氨酸脱羧酶抗体(GADA)检测。根据中华医学会糖尿病学分会(CDS)LADA诊疗的共识,将其分为LADA组(18例)和T2DM组(284例)。分析两组患者的一般临床资料和临床生化指标;采用多重线性回归方法,评估建立LADA诊断模型的可行性。结果⑴与T2DM组患者相比,LADA组患者起病年龄更轻,"三多一少"症状更多见(P<0.05);体重、体重指数(BMI)、腰围、腰臀比(WHR)、甘油三酯(TG)、空腹C肽(FCP)、餐后2 h C肽(2 h-CP)、改良胰岛功能指数[HOMA-islet(CP-DM)]、改良胰岛素抵抗指数[HOMA-IR(CP)]均更低,而高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbA1c)更高(P<0.05)。⑵采用线性回归方法对LADA组患者与T2DM组患者进行多重共线性分析,将差异有统计学意义的生化指标经相关性分析筛选出无多重共线性的指标作为自变量,以GADA数值作为因变量,统计结果显示自变量不能完全满足多重线性回归分析的条件。结论⑴相关临床特征和糖代谢指标对LADA有鉴别诊断意义,但本研究不能进行多重线性回归分析,难以建立LADA诊断模型。⑵LADA诊断是一种综合性诊断,应结合胰岛自身抗体结果与临床特征。
Objective To analyze the clinical features of latent autoimmune diabetes(LADA)in adults among newly diagnosed type 2 diabetes mellitus(T2DM),and to explore whether LADA diagnostic models can be established based on this.Methods From May 2016 to January 2017,302 patients with newly diagnosed T2DM in the outpatient and inpatient department of metabolism and endocrinology of Yueyang Central Hospital were analyzed.All of them were tested for glutamic acid decarboxylase antibody(GADA).According to the consensus of the Chinese Medical Association Diabetes Association(CDS)LADA diagnosis and treatment,they were divided into LADA group(18 cases)and T2DM group(284 cases).The general clinical data and clinical biochemical indexes of the two groups were analyzed;Multiple linear regression method was used to evaluate the feasibility of establishing LADA diagnostic model.Results(l)Compared with patients in the T2DM group,the patients in the LADA group had a younger age of onset,and"three more and one less"symptoms were more common(P<0.05);the weight,body mass index(BMI),waist circumference,waist-to-hip ratio(WHR),triglycerides(TG),fasting C peptide(FCP),postprandial 2 h C peptide(2 h-CP),modified islet function index HOMA-islet(CP-DM),and modified insulin resistance index HOMA-IR(CP)in the LADA group were all lower,while high-density lipoprotein cholesterol(HDL-C)and HbAl c were higher(P<0.05).(2)the linear regression method was used to analyze the multicollinearity of patients in LADA group and T2DM group.The biochemical indexes with statistically significant difference were selected as independent variables through correlation analysis,and the GADA value was used as dependent variable.The statistical results showed that the independent variables could not fully meet the conditions of multicollinearity regression analysis.Conclusions(1)Related clinical features and glucose metabolism indicators have differential diagnosis significance for LADA,but this study cannot be used for multiple linear regression analysis,and it is dif
作者
罗长青
黄干
雷康
刘珊
周智广
Luo Changqing;Huang Gan;Lei Kang;Liu Shan;Zhou Zhiguang(Department of Metabolism and Endocrinology,The Second Xiangya Hospital of Central South University,National Clinical Research Center for Metabolic Disease,Changsha 410011,China;Department of Metabolism and Endocrinology,Yueyang Central Hospital,Yueyang 414000,China)
出处
《中国医师杂志》
CAS
2021年第10期1496-1500,共5页
Journal of Chinese Physician
基金
国家科技支撑计划项目(2015BAI12B13)。
