中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
20期
1563-1567
,共5页
黄干%孙贵中%杨琳%李霞%向宇飞%周智广
黃榦%孫貴中%楊琳%李霞%嚮宇飛%週智廣
황간%손귀중%양림%리하%향우비%주지엄
糖尿病,1型%谷氨酸脱羧酶%自身抗体%蛋白酪氨酸磷酸酶%锌转运体8
糖尿病,1型%穀氨痠脫羧酶%自身抗體%蛋白酪氨痠燐痠酶%鋅轉運體8
당뇨병,1형%곡안산탈최매%자신항체%단백락안산린산매%자전운체8
Diabetes mellitus,type 1%Glutamate decarboxylase%Autoantibodies%Protein tyrosine phosphatase%Zinc transporter 8
目的 研究锌转运体8自身抗体(ZnT8A)和蛋白酪氨酸磷酸酶自身抗体(IA-2A)阳性的成人隐匿性自身免疫糖尿病(LA DA)患者胰岛功能的变化特点,为LADA的早期干预提供依据.方法 选择2005至2010年在我院就诊的初诊谷氨酸脱羧酶抗体(GADA)+ ZnT8A双阳性的LADA患者13例(GADA+ ZnT8A双阳性组),GADA+ IA-2A双阳性的LADA患者14例(GADA+ IA-2A双阳性组),GADA单独阳性的LADA患者42例(GADA单独阳性组),并选择同期抗体阴性的2型糖尿病(T2DM)患者40例作为对照组.对各组患者每年随访1次,连续随访3年,检测并比较各组患者基线和随访期间空腹血糖(FBG)、糖化血红蛋白(HbAl c)、空腹和餐后2hC肽(FCP、2 h CP)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平等临床指标的变化情况.本研究经中南大学湘雅二医院伦理委员会批准[(2006)伦审第(S05)号].结果 GADA+ IA-2A双阳性组FBG和HbAlc均高于GADA单独阳性组[(10.5±3.6) mmol/L、(9.3±2.6)％比(9.2±2.0) mmol/L、(7.4±2.0)％,P=0.017,0.011]和对照组[(10.5±3.6) mmol/L、(9.3±2.6)％比(8.5±1.2) mmol/L、(7.2±2.1)％,P=0.007,0.013],而FCP水平为415(68 ～934)pmol/L,低于GADA单独阳性组[538(224 ～1 146) pmol/L]以及对照组[643(163～l 658)pmol/L],P=0.015,0.003.GADA+ ZnT8A双阳性组、GADA+IA-2A双阳性组和GADA单独阳性组的空腹C肽水平均呈逐年下降趋势.GADA+ ZnT8A双阳性组和GADA+ IA-2A双阳性组空腹C肽水平年平均下降率为14.2％和12.4％,高于GADA单独阳性组和对照组的7.9％和0(均P＜0.01).结论 GADA合并IA-2A阳性的LADA患者初诊时胰岛功能较差,且ZnT8A和IA-2A均能加速LADA患者随病程延长而出现的胰岛功能衰竭.
目的 研究鋅轉運體8自身抗體(ZnT8A)和蛋白酪氨痠燐痠酶自身抗體(IA-2A)暘性的成人隱匿性自身免疫糖尿病(LA DA)患者胰島功能的變化特點,為LADA的早期榦預提供依據.方法 選擇2005至2010年在我院就診的初診穀氨痠脫羧酶抗體(GADA)+ ZnT8A雙暘性的LADA患者13例(GADA+ ZnT8A雙暘性組),GADA+ IA-2A雙暘性的LADA患者14例(GADA+ IA-2A雙暘性組),GADA單獨暘性的LADA患者42例(GADA單獨暘性組),併選擇同期抗體陰性的2型糖尿病(T2DM)患者40例作為對照組.對各組患者每年隨訪1次,連續隨訪3年,檢測併比較各組患者基線和隨訪期間空腹血糖(FBG)、糖化血紅蛋白(HbAl c)、空腹和餐後2hC肽(FCP、2 h CP)、甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)水平等臨床指標的變化情況.本研究經中南大學湘雅二醫院倫理委員會批準[(2006)倫審第(S05)號].結果 GADA+ IA-2A雙暘性組FBG和HbAlc均高于GADA單獨暘性組[(10.5±3.6) mmol/L、(9.3±2.6)％比(9.2±2.0) mmol/L、(7.4±2.0)％,P=0.017,0.011]和對照組[(10.5±3.6) mmol/L、(9.3±2.6)％比(8.5±1.2) mmol/L、(7.2±2.1)％,P=0.007,0.013],而FCP水平為415(68 ～934)pmol/L,低于GADA單獨暘性組[538(224 ～1 146) pmol/L]以及對照組[643(163～l 658)pmol/L],P=0.015,0.003.GADA+ ZnT8A雙暘性組、GADA+IA-2A雙暘性組和GADA單獨暘性組的空腹C肽水平均呈逐年下降趨勢.GADA+ ZnT8A雙暘性組和GADA+ IA-2A雙暘性組空腹C肽水平年平均下降率為14.2％和12.4％,高于GADA單獨暘性組和對照組的7.9％和0(均P＜0.01).結論 GADA閤併IA-2A暘性的LADA患者初診時胰島功能較差,且ZnT8A和IA-2A均能加速LADA患者隨病程延長而齣現的胰島功能衰竭.
목적 연구자전운체8자신항체(ZnT8A)화단백락안산린산매자신항체(IA-2A)양성적성인은닉성자신면역당뇨병(LA DA)환자이도공능적변화특점,위LADA적조기간예제공의거.방법 선택2005지2010년재아원취진적초진곡안산탈최매항체(GADA)+ ZnT8A쌍양성적LADA환자13례(GADA+ ZnT8A쌍양성조),GADA+ IA-2A쌍양성적LADA환자14례(GADA+ IA-2A쌍양성조),GADA단독양성적LADA환자42례(GADA단독양성조),병선택동기항체음성적2형당뇨병(T2DM)환자40례작위대조조.대각조환자매년수방1차,련속수방3년,검측병비교각조환자기선화수방기간공복혈당(FBG)、당화혈홍단백(HbAl c)、공복화찬후2hC태(FCP、2 h CP)、감유삼지(TG)、총담고순(TC)、고밀도지단백담고순(HDL-C)、저밀도지단백담고순(LDL-C)수평등림상지표적변화정황.본연구경중남대학상아이의원윤리위원회비준[(2006)륜심제(S05)호].결과 GADA+ IA-2A쌍양성조FBG화HbAlc균고우GADA단독양성조[(10.5±3.6) mmol/L、(9.3±2.6)％비(9.2±2.0) mmol/L、(7.4±2.0)％,P=0.017,0.011]화대조조[(10.5±3.6) mmol/L、(9.3±2.6)％비(8.5±1.2) mmol/L、(7.2±2.1)％,P=0.007,0.013],이FCP수평위415(68 ～934)pmol/L,저우GADA단독양성조[538(224 ～1 146) pmol/L]이급대조조[643(163～l 658)pmol/L],P=0.015,0.003.GADA+ ZnT8A쌍양성조、GADA+IA-2A쌍양성조화GADA단독양성조적공복C태수평균정축년하강추세.GADA+ ZnT8A쌍양성조화GADA+ IA-2A쌍양성조공복C태수평년평균하강솔위14.2％화12.4％,고우GADA단독양성조화대조조적7.9％화0(균P＜0.01).결론 GADA합병IA-2A양성적LADA환자초진시이도공능교차,차ZnT8A화IA-2A균능가속LADA환자수병정연장이출현적이도공능쇠갈.
Objective To observe the changes of islet function in ZnT8A positive and IA-2A positive patients so as to provide rationales for early intervention of LADA patients.Methods A total of 69 outpatients and inpatients with newly diagnosed LADA testing for GADA,IA-2A and ZnT8A by radioligand binding assay (RBA) were enrolled from 2005 to 2010,including 13 with double positive for GADA and ZnT8A (GADA + ZnT8A double positive group),14 with double positive for GADA and IA-2A (GADA + IA-2A double positive group) and 42 with positive for GADA alone (GADA positive group),40 type 2 diabetes mellitus (T2DM) patients negative for the above three autoantibodies were selected as control subjects (T2DM group).The baseline clinical data of all groups were compared and all patients were followed annually for 3 years.Fasting plasma glucose (FBG),HbA1 c,fasting C-peptide (FCP),C-peptide 2 h after meal (2 h CP),triglyceride (TG),total cholesterol (TC),high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were detected and compared among the above groups during the follow-ups.Results Compared to GADA positive group and T2DM group,the GADA + IA-2A double positive group had higher level of baseline FBG and HbA1c ((10.5 ± 3.6) mmol/L and (9.3±2.6)％ vs (9.2±2.0) mmol/L and(7.4±2.0)％,P=0.017,0.011) and had lower level of baseline FCP (415(68-934) vs 538(224-1 146)and 643(163-1 658)pmol/L,P =0.015,0.003).During the follow-ups,FCP decreased year-on-year in GADA + ZnT8A double positive,GADA + IA-2A double positive and GADA positive groups.The annual average rate of decrease in FCP was more rapid in GADA + ZnT8A double positive and GADA + IA-2A double positive groups than those in GADA positive alone and T2DM groups (all P ＜ 0.01).Conclusions The islet functions of newly diagnosed LADA patients with GADA and IA-2A positive are much worse.And emergence of ZnT8A and IA-2A may accelerate the failure of islet function with diabetic progress in LADA patients.
