CAJ | 학술논문

目的探讨谷氨酸脱羧酶抗体(GAD-Ab)、蛋白酪氨酸磷酸酶抗体(IA-2Ab)和SOX13抗体(SOX13-Ab)在不同发病年龄的酮症倾向糖尿病(KPD)患者中的分布规律及其与临床特征的相关性.方法 250例KPD患者分为不同的发病年龄组(≤12岁,13～18岁,19～44岁,≥45岁),比较各组患者上述三种抗体的分布规律,探讨胰岛自身抗体异质性对KPD患者临床表型的影响.结果 (1)随发病年龄增加,GAD-Ab、IA-2Ab阳性率呈递减趋势,SOX13-Ab阳性率呈递增趋势;其中,儿童(≤12岁)及青少年(13～18岁)发病的KPD患者中GAD-Ab阳性率显著高于IA-2Ab及SOX13-Ab阳性率,儿童发病组中GAD-Ab/IA-2Ab双阳性率显著高于成年发病(≥19岁)组(P均<0.05).(2)儿童及青少年发病者表现为低BMI、低代谢综合征(MS)及低大血管/微血管并发症发生率(病程≤5年);而中老年(≥45岁)发病者具有胰岛功能好、MS发生率高等特点(P均<0.05).(3)GAD-Ab、IA-2Ab及SOX13-Ab任一阳性的KPD患者中,IA-2Ab/SOX13-Ab双阳性组胰岛功能显著高于其他抗体状态组.结论 KPD患者中GAD-Ab、IA-2Ab及SOX13-Ab的分布具有与发病年龄相关的异质性,这可部分解释不同发病年龄KPD患者临床特征的差异性.
목적 탐토곡안산탈최매항체(GAD-Ab)、단백락안산린산매항체(IA-2Ab)화SOX13항체(SOX13-Ab)재불동발병년령적동증경향당뇨병(KPD)환자중적분포규률급기여림상특정적상관성.방법 250례KPD환자분위불동적발병년령조(≤12세,13～18세,19～44세,≥45세),비교각조환자상술삼충항체적분포규률,탐토이도자신항체이질성대KPD환자림상표형적영향.결과 (1)수발병년령증가,GAD-Ab、IA-2Ab양성솔정체감추세,SOX13-Ab양성솔정체증추세;기중,인동(≤12세)급청소년(13～18세)발병적KPD환자중GAD-Ab양성솔현저고우IA-2Ab급SOX13-Ab양성솔,인동발병조중GAD-Ab/IA-2Ab쌍양성솔현저고우성년발병(≥19세)조(P균<0.05).(2)인동급청소년발병자표현위저BMI、저대사종합정(MS)급저대혈관/미혈관병발증발생솔(병정≤5년);이중노년(≥45세)발병자구유이도공능호、MS발생솔고등특점(P균<0.05).(3)GAD-Ab、IA-2Ab급SOX13-Ab임일양성적KPD환자중,IA-2Ab/SOX13-Ab쌍양성조이도공능현저고우기타항체상태조.결론 KPD환자중GAD-Ab、IA-2Ab급SOX13-Ab적분포구유여발병년령상관적이질성,저가부분해석불동발병년령KPD환자림상특정적차이성.
Objective To explore the distribution of glutamic acid decarboxylase antibody（GAD-Ab）,protein tyrosine phosphatase antibody(IA-2Ab) and SOX13 antibody(SOX13-Ab) in ketosis-prone diabetes（KPD）with different onset age, and to investigate the onset age-dependent influence of islet antibody heterogeneity on KPD clinical characteristics. Methods The 250 KPD patients were divided into four subgroups with different onset age(≤12 years，13～18 years，19～44 years，≥45 years), then to compare their clinical characteristics and to analyze the distribution of GAD-Ab,IA-2Ab and SOX13-Ab in the four KPD subgroups. ResultsAlong with the increase of the onset age of KPD, the positive rate of GAD-Ab and IA-2Ab gradually reduced, while the positive rate of SOX13-Ab gradually increased. In the subgroup with onset age ≤18years, the positive rate of GAD-Ab was significantly higher than that of IA-2Ab and SOX13-Ab. The positive rate of GAD-Ab/IA-2Ab in patients with onset age ≤12 years was significantly higher than that in patients with onset age≥19 years.Patients with onset age≤18 years were mainly characterized by lower BMI, lower incidences of metabolic syndrome（MS），microvascular complications and macrovascular complications. While patients with onset age≥45 years mainly manifested with higher islet β cell function and higher incidence of MS. The β cell function of patients positive for both IA-2Ab and SOX13-Ab was significantly higher than that of patients with any other antibody status. Conclusions The onset age-dependent heterogeneity of GAD-Ab,IA-2Ab and SOX13-Ab distribution may contribute to the variety of clinical manifestations of KPD patients.