目的 探讨成人晚发性自身免疫糖尿病(LADA)与自身免疫性甲状腺疾病(AITD)的关系,并分析LADA患者发生AITD的危险因素.方法 对80例LADA患者、80例2型糖尿病(T2DM)患者和80例健康对照者进行游离三碘甲腺原氨酸(FT3)、血清游离甲状腺素(FT4)、血清超敏促甲状腺素(uTSH)、甲状腺过氧化物酶抗体(TPO-Ab)、甲状腺球蛋白抗体(TG-Ab)检测.糖尿病患者还进行谷氨酸脱羧酶抗体(GADA)、胰岛素自身抗体(IAA)、胰岛细胞抗体(ICA)检测.采用放免法检测TPO-Ab、TG-Ab、FT3、FT4,直接化学发光法检测uTSH,放射配体法检测GADA、IAA、ICA.随访2年后对以上指标进行复查.结果 (1) LADA患者的基线TG-Ab及TPO-Ab阳性率分别为18.8%、21.3%,均高于T2DM患者的8.8%、13.8%和健康对照者的10.0%、12.5%,差异均有统计学意义(P<0.05).2年后随访,LADA患者的TG-Ab及TPO-Ab阳性率升至21.3%、23.8%,均高于T2DM患者的10.0%、12.5%和健康对照者的8.8%、16.3%,差异均有统计学意义(P<0.05).(2)与甲状腺自身抗体阴性者相比,阳性者的LADA患者随访前后高滴度GADA (GADA≥0.3)所占比例较高(53.1%vs 22.9%和46.9%vs 20.8%,P均<0.05),随访前后uTSH异常率更高(18.8%vs 6.3%和28.1%vs 8.3%,P均<0.05),女性比例更高(65.6%vs 27.1%,P<0.05),空腹及2 h C肽水平更低(P<0.05),身高体重指数更低(P<0.05),发病年龄更小(P<0.05),而甲状腺疾病家族史及其他自身免疫疾病家族史比较则差异均无统计学意义(P>0.05).(3)高滴度GADA的LADA患者与低滴度的LADA患者比较,随访前后TG-Ab阳性率均较高(25.0%vs 15.4%和32.1%vs 15.4%,P均<0.05),随访前后TPO-Ab阳性率均较高(42.9%vs 9.6%和50.0%vs 9.6%,P均<0.05),随访前后甲状腺功能异常率较高(35.7%vs 17.3%和42.9%vs 19.2%,P均<0.05),发病年龄更小(P<0.05),空腹及2 h C肽水平更低(P<0.05),而女性比例及家族史比较则差异无统计学意义(P>0.05).(4) Logistic回归分析显示,女性、高滴度GADA、入组时甲状腺自身抗体(TPO-Ab、TG-Ab)阳性是LADA患者未来发生甲状腺功能异常的危险因素.结论 LADA患者,尤其是高滴度GADA者,发生甲状腺自身免疫紊乱的风险高于T2DM及健康对照者;女性、高滴度GADA、甲状腺自身抗体阳性是LADA患者将来发生甲状腺功能异常的危险因素;由于LADA有并发甲状腺功能异常的风险,推荐在LADA患者中常规筛查甲状腺自身抗体.
目的 探討成人晚髮性自身免疫糖尿病(LADA)與自身免疫性甲狀腺疾病(AITD)的關繫,併分析LADA患者髮生AITD的危險因素.方法 對80例LADA患者、80例2型糖尿病(T2DM)患者和80例健康對照者進行遊離三碘甲腺原氨痠(FT3)、血清遊離甲狀腺素(FT4)、血清超敏促甲狀腺素(uTSH)、甲狀腺過氧化物酶抗體(TPO-Ab)、甲狀腺毬蛋白抗體(TG-Ab)檢測.糖尿病患者還進行穀氨痠脫羧酶抗體(GADA)、胰島素自身抗體(IAA)、胰島細胞抗體(ICA)檢測.採用放免法檢測TPO-Ab、TG-Ab、FT3、FT4,直接化學髮光法檢測uTSH,放射配體法檢測GADA、IAA、ICA.隨訪2年後對以上指標進行複查.結果 (1) LADA患者的基線TG-Ab及TPO-Ab暘性率分彆為18.8%、21.3%,均高于T2DM患者的8.8%、13.8%和健康對照者的10.0%、12.5%,差異均有統計學意義(P<0.05).2年後隨訪,LADA患者的TG-Ab及TPO-Ab暘性率升至21.3%、23.8%,均高于T2DM患者的10.0%、12.5%和健康對照者的8.8%、16.3%,差異均有統計學意義(P<0.05).(2)與甲狀腺自身抗體陰性者相比,暘性者的LADA患者隨訪前後高滴度GADA (GADA≥0.3)所佔比例較高(53.1%vs 22.9%和46.9%vs 20.8%,P均<0.05),隨訪前後uTSH異常率更高(18.8%vs 6.3%和28.1%vs 8.3%,P均<0.05),女性比例更高(65.6%vs 27.1%,P<0.05),空腹及2 h C肽水平更低(P<0.05),身高體重指數更低(P<0.05),髮病年齡更小(P<0.05),而甲狀腺疾病傢族史及其他自身免疫疾病傢族史比較則差異均無統計學意義(P>0.05).(3)高滴度GADA的LADA患者與低滴度的LADA患者比較,隨訪前後TG-Ab暘性率均較高(25.0%vs 15.4%和32.1%vs 15.4%,P均<0.05),隨訪前後TPO-Ab暘性率均較高(42.9%vs 9.6%和50.0%vs 9.6%,P均<0.05),隨訪前後甲狀腺功能異常率較高(35.7%vs 17.3%和42.9%vs 19.2%,P均<0.05),髮病年齡更小(P<0.05),空腹及2 h C肽水平更低(P<0.05),而女性比例及傢族史比較則差異無統計學意義(P>0.05).(4) Logistic迴歸分析顯示,女性、高滴度GADA、入組時甲狀腺自身抗體(TPO-Ab、TG-Ab)暘性是LADA患者未來髮生甲狀腺功能異常的危險因素.結論 LADA患者,尤其是高滴度GADA者,髮生甲狀腺自身免疫紊亂的風險高于T2DM及健康對照者;女性、高滴度GADA、甲狀腺自身抗體暘性是LADA患者將來髮生甲狀腺功能異常的危險因素;由于LADA有併髮甲狀腺功能異常的風險,推薦在LADA患者中常規篩查甲狀腺自身抗體.
목적 탐토성인만발성자신면역당뇨병(LADA)여자신면역성갑상선질병(AITD)적관계,병분석LADA환자발생AITD적위험인소.방법 대80례LADA환자、80례2형당뇨병(T2DM)환자화80례건강대조자진행유리삼전갑선원안산(FT3)、혈청유리갑상선소(FT4)、혈청초민촉갑상선소(uTSH)、갑상선과양화물매항체(TPO-Ab)、갑상선구단백항체(TG-Ab)검측.당뇨병환자환진행곡안산탈최매항체(GADA)、이도소자신항체(IAA)、이도세포항체(ICA)검측.채용방면법검측TPO-Ab、TG-Ab、FT3、FT4,직접화학발광법검측uTSH,방사배체법검측GADA、IAA、ICA.수방2년후대이상지표진행복사.결과 (1) LADA환자적기선TG-Ab급TPO-Ab양성솔분별위18.8%、21.3%,균고우T2DM환자적8.8%、13.8%화건강대조자적10.0%、12.5%,차이균유통계학의의(P<0.05).2년후수방,LADA환자적TG-Ab급TPO-Ab양성솔승지21.3%、23.8%,균고우T2DM환자적10.0%、12.5%화건강대조자적8.8%、16.3%,차이균유통계학의의(P<0.05).(2)여갑상선자신항체음성자상비,양성자적LADA환자수방전후고적도GADA (GADA≥0.3)소점비례교고(53.1%vs 22.9%화46.9%vs 20.8%,P균<0.05),수방전후uTSH이상솔경고(18.8%vs 6.3%화28.1%vs 8.3%,P균<0.05),녀성비례경고(65.6%vs 27.1%,P<0.05),공복급2 h C태수평경저(P<0.05),신고체중지수경저(P<0.05),발병년령경소(P<0.05),이갑상선질병가족사급기타자신면역질병가족사비교칙차이균무통계학의의(P>0.05).(3)고적도GADA적LADA환자여저적도적LADA환자비교,수방전후TG-Ab양성솔균교고(25.0%vs 15.4%화32.1%vs 15.4%,P균<0.05),수방전후TPO-Ab양성솔균교고(42.9%vs 9.6%화50.0%vs 9.6%,P균<0.05),수방전후갑상선공능이상솔교고(35.7%vs 17.3%화42.9%vs 19.2%,P균<0.05),발병년령경소(P<0.05),공복급2 h C태수평경저(P<0.05),이녀성비례급가족사비교칙차이무통계학의의(P>0.05).(4) Logistic회귀분석현시,녀성、고적도GADA、입조시갑상선자신항체(TPO-Ab、TG-Ab)양성시LADA환자미래발생갑상선공능이상적위험인소.결론 LADA환자,우기시고적도GADA자,발생갑상선자신면역문란적풍험고우T2DM급건강대조자;녀성、고적도GADA、갑상선자신항체양성시LADA환자장래발생갑상선공능이상적위험인소;유우LADA유병발갑상선공능이상적풍험,추천재LADA환자중상규사사갑상선자신항체.
Objective To investigate the relationship between latent autoimmune diabetes in adults (LA-DA) and autoimmune thyroid disease (AITD), and to analyze the risk factors for AITD in patients with LADA. Methods Eighty patients of LADA, 80 patients of type 2 diabetes mellitus (T2DM), and 80 healthy subjects were recruited. Physical examination was performed and sera were sampled for the measurement of thyroid peroxidase anti-body (TPO-Ab), thyroglobulin antibody (TG-Ab), glutamic acid decarboxylase autoantibody (GADA), insulin autoan-tibody (IAA), and islet cell antibody (ICA), free triiodothyronine (FT3), free thyroxine (FT4) and ultrasensitive thy-roid-stimulating hormone (uTSH). After 2 years of follow-up, the above indexes were reexamined. Results (1) At baseline, the positive rate of TPO-Ab and TG-Ab in patients of LADA (18.8%, 21.3%) was significantly higher than those in patients of T2DM (8.8%, 13.8%, P<0.05) and healthy subjects (10.0%, 12.5%, P<0.05). After 2 years of fol-low-up, the positive rate of TPO-Ab and TG-Ab in patients of LADA increased to 21.3%and 23.8%, which were high-er than those in patients of T2DM (10.0%, 12.5%, P<0.05) and healthy subjects (8.8%, 16.3%, P<0.05). (2) Compared with the patients of LADA without thyroid autoantibody, patients of LADA with thyroid autoantibody had higher pro-portion of high titer GADA (GADA≥0.3) before or after followed-up (53.1%vs 22.9%, 46.9%vs 20.8%, P<0.05), higher abnormal rates of uTSH before or after followed-up (18.8%vs 6.3%, 28.1%vs 8.3%, P<0.05), higher propor-tion of females (65.6%vs 27.1%, P<0.05), lower levels of fasting and 2 h C-peptide (P<0.05), lower body mass index (P<0.05), and younger age of onset (P<0.05). However, there was no statistically significant difference in family histo-ry of thyroid diseases and family history of autoimmune diseases (P>0.05). (3) Compared with LADA patients with low-titer GADA, the patients with high-titer GADA had higher positive rate of TG-Ab before and after follow-up (25.0% vs 15.4%, 2.1% vs 15.4%, P<0.05), higher positive rate of TPO-Ab before and after follow-up (42.9% vs 9.6%, 50.0%vs 9.6%, P<0.05), higher abnormal rate of uTSH before and after follow-up (35.7%vs 17.3%, 42.9%vs 19.2%, P<0.05), younger age of onset (P<0.05), and lower fasting and 2 h C-peptide level (P<0.05). However, there was no statistically significant difference in the proportion of females and family history (P>0.05). (4) Multiple logis-tic regression analysis revealed that female, high-titer GADA and positivity of thyroid antibody (TPO-Ab, TG-Ab) were the risk factors for thyroid dysfunction in LADA patients. Conclusion (1) LADA patients, especially those with high-titer GADA, have higher risk for thyroid autoimmunity dysfunction than T2DM patients and healthy sub-jects. Female, high-titer GADA and positivity of thyroid antibody are the risk factors for thyroid dysfunction in LADA patients. Because of the risk of thyroid dysfunction in LADA, it is recommended to regularly screen thyroid antibody in LADA patients.
