联合检测GAD-Ab和ICA对LADA的临床异质性特点研究

目的探讨中国人群成人隐匿性自身免疫性糖尿病(LADA)的临床异质性特点.方法对820例2型糖尿病患者检测谷氨酸脱羧酶抗体(GAD-Ab),并对其中自愿参加进一步研究的311例患者,根据GAD-Ab、胰岛细胞抗体(ICA)阳性结果分组,比较各组间临床特点.结果 (1)GAD-Ab在2型糖尿病中的阳性率为11.3%;(2)GAD-Ab阳性组与GAD-Ab阴性组相比,起病年龄、体质量指数(BMI)、空腹C肽、餐后2 h C肽低,发生酮症的机会多,而高血压、高血脂发生率低;(3)LADA患者中LADA-1与LADA-2相比较,具有胰岛功能更差,体质量较低,更需胰岛素治疗而高血压、高血脂发生率低等特点,临床表现更似经典的1型糖尿病.结论中国人群LADA临床表现存在着异质性改变,可通过对GAD-Ab和ICA的联合检测来判断.     

糖尿病患者胰岛自身抗体检测的临床意义

目的探讨胰岛自身抗体在糖尿病诊断中的意义。方法采用ELISA法分别检测I型DM、成人隐匿性自身免疫性糖尿病(LADA)、II型DM患者血清谷氨酸脱羧酶抗体(GAD)、胰岛细胞抗体(ICA)、胰岛素自身抗体(IAA);并对DM患者空腹血糖及C肽和餐后120minC肽进行检测。结果I型糖尿病患者GAD的阳性率为41.2%,ICA为35.3%,IAA为23.5%;LADA组GAD的阳性率为28.6%,ICA和IAA均为21.4%,两组与II型DM组相比,有显著性差异。胰岛抗体阳性与阴性DM患者相比,在起病年龄、病程、空腹血糖及C肽均有显著性差异。结论胰岛自身抗体的检测对糖尿病的正确分型具有重要的指导作用。     

成人晚发性自身免疫性糖尿病自身免疫抗体的研究进展

成人晚发性自身免疫性糖尿病(LADA)属于Ⅰ型糖尿病(DM)的亚型，其早期临床表现与2型DM相似，胰岛B细胞所受的免疫损伤呈缓慢性，数年后需胰岛素治疗。本病具有低C肽水平、低体质指数等趋向于Ⅰ型DM的临床特点，血清谷氨酸脱羧酶抗体(GADAb)、胰岛细胞抗体(ICA)等自身免疫抗体阳性。由于检测方法、研究类型以及人种、地区的差异，LADA在DM中所占的比例(按GADAb、ICA的阳性率计算)，各家报道不一。Zimmet认为，在成人起病的DM患者中有10%-20％为LADA。     

三种自身抗体联合检测对成人隐匿性自身免疫性糖尿病的诊断价值

目的通过对血清谷氨酸脱羧酶抗体(GAD-Ab)、酪氨酸磷酸酶样蛋白抗体(IA-2A)和胰岛细胞抗体(ICA)联合检测,探讨其对成人隐匿性自身免疫性糖尿病(LADA)的诊断价值。方法用ELISA法测定157例临床诊断为2型糖尿病患者及49例健康查体者的血清GAD-Ab、IA-2A和ICA,并比较抗体阳性和阴性患者的临床特征。结果临床诊断为2型糖尿病的患者GAD-Ab、IA-2A和ICA的阳性率与对照组比较差异有统计学意义(χ2=8.10,8.51,P<0.01;χ2=4.08,P<0.05),且ICA的阳性率低于GAD-Ab、IA-2A阳性率(χ2=5.78,P<0.05);抗体阳性组患者空腹及餐后2 h血清C肽水平较抗体阴性组明显降低(t=9.606,11.175,P<0.001)。结论胰岛自身抗体联合检测可提高LADA患者的检出率;LADA患者胰岛储备功能较差。     

胰岛自身抗体测定对成人隐匿性自身免疫糖尿病的诊断价值

目的:探讨谷氨酸脱羧酶抗体(GADA)、胰岛细胞抗体(ICA)和抗胰岛素抗体(IAA)在成人隐匿性自身免疫糖尿病(LADA)诊断中的价值。方法:入选150例初诊为2型糖尿病(T2DM)的患者和80例正常糖耐量者,测定其血清GADA、ICA和IAA,并行胰岛素释放试验及C肽释放试验。结果:初诊为T2DM患者血清中GADA、ICA及IAA抗体的阳性率分别为20.0%、14.0%和8.0%,有一种或以上抗体阳性者占30%。与对照组比较,血清中有一种或以上胰岛自身抗体阳性的DM患者的胰岛素和C肽分泌水平明显下降,其中三种抗体全阳性组患者下降最为显著,差别均有统计学意义(P<0.01)。结论:临床初诊为T2DM的病人中存在被误诊的LADA患者,多种胰岛自身抗体联合检测可提高LADA的检出率。     

老年Ⅱ型糖尿病患者血清谷氨酸脱氢酶抗体测定的临床意义

GAD抗体及ICA是胰岛自身免疫损伤的标志。研究表明其与Ⅰ型糖尿病及LADA有很好的相关性 ;对于老年Ⅱ型糖尿病的有关研究尚少见 ,本文旨在了解老年Ⅱ型糖尿病患者GAD抗体的阳性率及其与病程 ,并发症的发生率 ,及胰岛素用量之间的关系。1　对象及方法1 1　对象　均为我院门诊及住院病人。年龄 6 0～ 84岁 ,男性 31例 ,女性 12例 ,经OGTT及C肽测定诊断为Ⅱ型糖尿病 ,并且正在接受饮食疗法及药物治疗。1 2　方法　GAD抗体以ELISA法测定 ,药盒由北京福瑞生物制品工程公司提供。1 3　统计处理　所有数据均用 x±s表示 ,组间比较用t检…     

早发2型糖尿病继发性磺脲类药物失效患者ICA和GADA检测的意义

目的探讨早发2型糖尿病继发性磺脲类药物失效患者胰岛细胞抗体(ICA)和谷氨酸脱羧酶抗体(GADA)检测的情况及临床意义。方法46例早发2型糖尿病继发性磺脲类药物失效患者(SF组)和48例早发2型糖尿病使用饮食和/或磺脲类药物血糖控制良好患者(对照组),分别测定两组患者的ICA和GADA以及进食100g面粉的馒头分别测定0、1、2、3h的血糖、胰岛素、C肽。结果SF组ICA和GADA阳性率明显高于对照组(P<0.001),并与胰岛B细胞功能呈负相关。结论早发2型糖尿病继发性磺脲类药物失效患者ICA、GADA的阳性率明显升高,胰岛B细胞功能更差,自身免疫机制可能是早发2型糖尿病患者继发性磺脲类药物失效的机制之一。成人隐匿性自身免疫糖尿病(LADA)可能是早发2型糖尿病患者继发性磺脲类药物失效的病因之一。     

糖尿病相关抗体与糖尿病分型及C-肽水平相关性分析

[目的]分析糖尿病相关抗体在1型糖尿病患者和2型糖尿病患者中的分布情况,分析其与胰岛β细胞功能的关系。[方法]选取2004年3月至2005年10月在山东省千佛山医院就诊的门诊和住院糖尿病患者和健康人群,检测血中GADAI、CA、IAA及C-肽。[结果]检测1型糖尿病患者25例,2型糖尿病患者380例,健康对照组30人。GADA、ICA的阳性率1型糖尿病患者分别为76.00%、60.00%,2型糖尿病患者分别为32.11%、31.58%(P<0.01);IAA阳性率在2组病人分别为20.00%、26.31%(P>0.05)。C-肽均值(ng/ml),3种抗体均阴性组(109人)为(2.57±1.37),正常对照组(30人)为(2.07±0.68),GADA阳性组(55人)为(1.50±0.84),IAA阳性组(37人)为(1.95±1.04),ICA阳性组(46人)为(1.61±0.89),3种抗体均阳性组(25人)为(1.87±1.04)。C-肽低值组与C-肽高值组比较,IAA阳性率分别为24.21%、16.09%(P>0.05),GADA阳性率分别为43.16%、14.94%(P<0.01),ICA阳性率分别为35.80%、13.79%(P<0.01)。[结论]GADAI、CA阳性率1型糖尿病患者明显高于2型糖尿病患者,胰岛相关抗体GADA阳性者常伴有C-肽水平降低。     

儿童糖尿病血清学分型诊断的临床流行病学评价

目的　探讨和评价儿童糖尿病血清学分型诊断方法的临床应用价值。　方法　选择临床确诊的儿童糖尿病患者 2 76例 ,空腹静脉采血进行谷氨酸脱羧酶 (GAD)抗体和抗胰岛细胞 (ICA)抗体测定 ,同时检测血糖、尿糖、糖耐量等项目。　结果　在Ⅰ型儿童糖尿病组中 ,GAD和ICA抗体阳性检出率明显高于Ⅱ型糖尿病组 ( χ2 =2 13.94,P <0 .0 1;χ2=184.86 ,P <0 .0 1) ,两抗体阳性检出率差异无显著意义 ( χ2 =10 .31,P >0 .0 5 ) ,但具有一定程度的统计学相关性 ( χ2 =33.2 3,P <0 .0 1,r =0 .8479) ;而在Ⅱ型儿童糖尿病组中 ,两抗体阳性检出率差异无显著意义 ( χ2 =1.45 ,P >0 .0 5 ) ,也无统计学相关性 ( χ2 =0 .0 8,P >0 .0 5 )。　结论　GAD和ICA抗体可单独作为糖尿病分型诊断的指标 ,两法联合检测并结合其他血清、临床流行病学资料 ,将有助于糖尿病的预测、早期分型诊断、指导临床用药和高危人群的筛查。     

儿童糖尿病知清学分型诊断的临床流行病学评价

目的　探讨和评价儿童糖尿病血清学分型诊断方法的临床应用价值。　方法　选择临床确诊的儿童糖尿病患者 2 76例 ,空腹静脉采血进行谷氨酸脱羧酶 (GAD)抗体和抗胰岛细胞 (ICA)抗体测定 ,同时检测血糖、尿糖、糖耐量等项目。　结果　在Ⅰ型儿童糖尿病组中 ,GAD和ICA抗体阳性检出率明显高于Ⅱ型糖尿病组 ( χ2 =2 13.94,P <0 .0 1;χ2=184.86 ,P <0 .0 1) ,两抗体阳性检出率差异无显著意义 ( χ2 =10 .31,P >0 .0 5 ) ,但具有一定程度的统计学相关性 ( χ2 =33.2 3,P <0 .0 1,r =0 .8479) ;而在Ⅱ型儿童糖尿病组中 ,两抗体阳性检出率差异无显著意义 ( χ2 =1.45 ,P >0 .0 5 ) ,也无统计学相关性 ( χ2 =0 .0 8,P >0 .0 5 )。　结论　GAD和ICA抗体可单独作为糖尿病分型诊断的指标 ,两法联合检测并结合其他血清、临床流行病学资料 ,将有助于糖尿病的预测、早期分型诊断、指导临床用药和高危人群的筛查。     

Latent autoimmune diabetes in adults(LADA): part of the clinical spectrum of type-1 diabetes mellitus of autoimmune origin]

According to the most recent classification of diabetes mellitus the latent autoimmune diabetes in adults belongs to the group of type 1 autoimmune diabetes mellitus, as a slowly progressive form. It is not clear whether LADA is a distinct clinical entity or it is a part of the clinical spectrum of type 1 diabetes mellitus. The authors compare the antropologic (body mass index, waist to hip ratio), immunologic (occurrence of islet cell cytoplasmic autoantibodies and autoantibodies against glutamic acid decarboxylase and tyrosin phosphatase), genetic (HLA DR and DQ alleles known to be associated to type 1 diabetes mellitus) characteristics and occurrence of the features of the metabolic syndrome in the groups of type 1 and type 2 diabetes and LADA. 81 type 1 and 190 type 2 diabetics and 38 LADA patients were involved into the study. Freshly diagnosed type 1 diabetics served for controls of the autoantibody study: 48 patients manifested < or = 16 years of age and 89 type 1 diabetics manifested above 16 years of age. The three main diabetic groups differed in age: the average age in the type 1, type 2 and LADA groups were 37, 63 and 58 years respectively. There was no difference among the three groups in gender. The duration of the disease differed significantly between the type 2 and LADA groups (4.0 and 8.0 years respectively). In spite of the shorter duration of the disease in the LADA group, compared to the type 2 diabetics the frequency of insulin dependency was significantly higher in the LADA (81.6%) than in the type 2 group (46.7%). The BMI and WHR were comparable between the type 1 and LADA patients (average values were 23 and 0.83 in type 1 patients and 23.25 and 0.89 in LADA). The type 2 group differed significantly from type 1 and LADA (average values were 29.1 and 0.5). The concentration of glycated hemoglobin was comparable in the three groups. But there was a significant difference in HbA1c concentration between the freshly diagnosed subgroups of type 1 and LADA patients: 10.85% and 8% respectively. The fasting C-peptid levels were significantly higher in the sera of type 2 diabetics (0.75 pmol/l) compared to type 1 (0.2 pmol/l) and LADA patients (0.29 pmol/l). There was a significant difference in C-peptid concentrations between the type 1 and LADA groups, too. The insulin deficiency in LADA seemed to be not as severe as in type 1 diabetes. The serum total cholesterol and triglyceride levels were significantly higher and the HDL cholesterol concentration significantly lower in type 2 diabetics comparing to type 1 and LADA patients and there was no significant difference in this respect between the type 1 and LADA groups. The frequency of occurrence of hypertension differed no significantly between type 2 and LADA, but that of in type 1 diabetes was significantly lower than both type 2 and LADA. The occurrence of multiple autoantibodies (ICA + GADA + anti-IA2) was much more frequent in type 1 diabetes compared to LADA. In the sera of LADA patients the occurrence of ICA and GADA alone or ICA + GADA was characteristic (31.5% - 21.1% - 15.8% respectively). There was no difference between type 1 diabetes and LADA in the occurrence of the alleles of the MHC kown to be associated with type 1 diabetes. The occurrence of the haplotypes HLA DQ2/DR3 and/or DQ8/DR4 was observed in two thirds of type 1 diabetic and LADA patients. Chronic diabetic complications were observed in all of the groups and there was only a secondary connection of the complications with the type of the diabetes. Based on the results the authors suggest that LADA is a part of the clinical spectrum of type 1 diabetes of autoimmune origin.     

成人隐匿性自身免疫糖尿病32例临床特征分析

目的观察分析成人隐匿性自身免疫糖尿病(LADA)患者的临床特征,提高其防治水平。方法将32例GAD-Ab阳性LADA患者作为研究对象,均测量身高、体重、腰臀比、血压,并测定空腹血糖、血脂、C肽、HbA1c和标准餐后2h血糖、C肽。结果 LADA患者发病年龄范围较广,胰岛素的分泌能力较T2DM差,存在胰岛素抵抗。部分患者体形肥胖,伴有高血压和(或)血脂异常。结论 LADA患者既存在胰岛素缺乏,又有胰岛素抵抗,LADA患者诊断后需要尽早使用胰岛素治疗,可联用胰岛素增敏剂治疗改善胰岛素抵抗。     

谷氨酸脱羧酶抗体在初诊成人2型糖尿病患者中的阳性率及其分布特点

目的探讨谷氨酸脱羧酶抗体（GAD—Ab）在初诊成人2型糖尿病患者中的阳性率及其分布特点。方法用放射配体法检测2035例临床初诊为2型糖尿病（T2DM）患者的GAD—Ab，分析GAD—Ab的阳性率及其分布与临床特征的关系。结果①成人隐匿性自身免疫糖尿病在以医院为基础、初诊T2DM患者中的患病率为7．1％（145／2035），与在欧美高加索人中进行的大规模研究UKPDS的结果差异无统计学意义（8．7％us．9．8％，P=0．391），而高于ADOPT研究（8．0％VS．4．2％，P=0．000）和日本的Ehime研究结果（7．1％VS．3．8％，P=0．000）；②GAD—Ab的阳性率和滴度分布与起病年龄、体重指数和空腹c肽等临床特征有关，起病年龄小、体重指数低和空腹c肽低者具有较高的阳性率和滴度。结论①中国成人初诊T2DM患者的GAD—Ab阳性率与欧美高加索人接近，而高于日本人群；②GAD—Ab的阳性率和滴度与糖尿病患者的临床特征存在关联。     

GAD-Ab阳性的妊娠糖尿病患者胰岛素敏感性与β细胞功能变化

目的探讨谷氨酸脱羧酶抗体(GAD-Ab)阳性的妊娠糖尿病(GDM)患者胰岛素敏感性与β细胞功能变化。方法选取GDM孕妇84例(GDM组)和糖耐量正常孕妇82例作对照组(NGT组),孕期24~28周测定GAD-Ab和胰岛素水平及糖代谢指标,随访GDM产后6~12周和产后2年胰岛素水平及糖代谢指标。采用稳态模式胰岛素抵抗指数(HOMA-IR)评价胰岛素敏感性,稳态模式胰岛β细胞功能指数(HBCI)和30 min净增胰岛素/30 min净增血糖比值(ΔI30/ΔG30)评价胰岛β细胞分泌功能。结果⑴GDM组的HOMA-IR高于NGT组,差异有统计学意义(P<0.05);GDM组ΔI30/ΔG30和HBCI低于NGT组,差异有统计学意义(P<0.05);⑵GDM组中GAD-Ab阳性率17.0%,而NGT组中GAD-Ab阳性率1.0%,两组比较差异有统计学意义(P<0.01);⑶GAD-Ab阳性的GDM孕妇有糖尿病家族史、在孕期需胰岛素治疗者所占比例均高于抗体阴性组(P<0.05),GAD-Ab阳性的GDM孕妇HOMA-IR高于抗体阴性组,而ΔI30/ΔG30和HBCI均低于抗体阴性组,差异均有统计学意义(P<0.05);⑷GAD-Ab阳性GDM孕妇于产后6~12周和2年空腹血糖(FPG)、餐后血糖(2hPG)、糖化血红蛋白(HbA1c)均高于抗体阴性组(P<0.05~0.01),而产后2年ΔI30/ΔG30、HBCI明显下降,GAD-Ab阴性的GDM孕妇的胰岛功能在随访期间则无显著变化。结论 GAD-Ab阳性是胰岛β细胞功能损伤的一个预测指标;GDM孕妇中混有一些亚临床状态的1型糖尿病患者。     

Immigration and acculturation in relation to health and health-related risk factors among specific Asian subgroups in a health maintenance organization

OBJECTIVES: We sought to determine how risk factors for disease vary among Asian subgroups. METHODS: Using data from a case-control study conducted at Northern California Kaiser Medical Centers (from 1996 to 2001), we compared prevalence of selected risk factors among Asian subgroups and evaluated the associations of these risk factors with sociodemographic factors. RESULTS: Chinese and Japanese patients had a lower body mass index (kg/m(2)) than did other Asians. In all subgroups, being born in the United States was associated with having a body mass index greater than 25 kg/m(2). Compared with other Asians, more Japanese and multiple-race Asians smoked, and more Filipino and multiple-race Asian smokers started smoking at 18 years or younger. Filipinos and multiple-race Asians also were more likely to report diabetes. CONCLUSIONS: These data support the importance of efforts to distinguish among Asian subgroups in public health practice and research.     

2010年某综合医院高血压患者高脂血症影响因素分析

目的探讨高血压患者的血脂情况,旨在为高血压患者合并高血脂患者的治疗提供一定的实验数据。方法对2010年1月1日～2010年12月31日在某院心内科住院治疗的1217例高血压患者的临床资料进行收集并分析。结果单因素Logistic回归分析发现:体重指数、家族史、长期大量饮酒、长期吸烟、肾功能减退及肝功能异常是高血压患者合并高脂血症的危险因素;低脂饮食及每周运动是高血压合并高脂血症的保护因素。多因素Logistic回归分析发现:体重指数、家族史及长期大量饮酒是高血压患者合并高脂血症的危险因素;低脂饮食及每周运动是高血压合并高脂血症的保护因素。结论高血压患者应该低盐饮食并坚持体育锻炼及减轻体重有利于高血压患者血脂的控制,而长期大量饮酒影响高血压患者的血脂的控制。     

2型糖尿病患者血浆Ghrelin水平的研究

目的　检测 2型糖尿病病人血浆Ghrelin水平 ,分析其与糖、脂代谢紊乱的关系。方法　测定 30例正常对照及 5 4例 2型糖尿病病人清晨空腹Ghrelin水平 ,及部分病人OGTT时Ghrelin的变化。结果　 2型糖尿病病人空腹Ghrelin低于正常对照组 (P =0 .0 0 2 ) ,并与胰岛素 (insulin)水平呈负相关 (r =- 0 .5 5 4 ,P <0 .0 1)。其中体质量正常亚组病人空腹Ghrelin低于正常对照组 (P =0 .0 4 9) ;而超重亚组显著低于正常对照组 (P =0 .0 0 1)。高血脂亚组病人空腹Ghrelin低于正常对照组 (P <0 .0 1) ;而血脂正常亚组与正常对照组差别无显著性 (P =0 .0 5 5 )。病人行OGTT后血浆Ghrelin水平下降 (P =0 .0 0 5 )。结论　 (1) 2型糖尿病病人清晨空腹Ghrelin水平低于对照 ,与insulin水平呈负相关 ;在糖负荷后血Ghrelin水平有明显下降 ;(2 ) 2型糖尿病伴超重或高血脂时空腹Ghrelin与正常对照相比明显降低。而血脂正常的病人与正常对照差异无显著性     

超重、肥胖和腹型肥胖与心血管代谢性疾病的关联研究

目的 了解超重、肥胖和腹型肥胖对心血管代谢性疾病的影响。方法 采用整群抽样方法,选取河南省开封市通许县673名15岁以上居民为调查对象进行横断面调查,并对研究对象进行问卷调查和体格检查,留取空腹和餐后2h静脉血进行血糖检测。结果 开封地区居民标化超重患病率为35.52%;标化肥胖患病率为14.18%;标化腹型肥胖患病率为42.62%。单因素logistic回归分析显示,超重、肥胖和腹型肥胖是高血压、2型糖尿病、高血脂的危险因素;腹型肥胖是冠心病和脑卒中的危险因素(P<0.05)。腹型肥胖的人群归因危险度(PAR)在高血压、2型糖尿病、高血脂和心脑血管疾病中均高于70%。结论 在对高危人群进行筛查时,腰围比体质指数更为重要。减少腹型肥胖人群比例对预防心血管代谢性疾病的意义更为重大。     

Ethnic Disparities in the Association of Body Mass Index with the Risk of Hypertension and Diabetes

Despite having lower body mass index (BMI) compared to other ethnic groups, Asians continue to develop significant metabolic diseases such as hypertension and diabetes. To evaluate the disparate association of BMI and risk of hypertension and diabetes in Asians. We retrospectively studied 150,753 adults from the 1985–2011 California Behavioral Risk Factor Survey. Trends in prevalence of obesity, hypertension, and diabetes were stratified by ethnicity. Multivariate logistic regression models evaluated the incremental effect of one unit BMI increase on risk of hypertension and diabetes and the disparate risks of hypertension and diabetes at different BMI thresholds. Asians had the lowest BMI among all groups. However, the impact of increasing BMI on risk of hypertension and diabetes was significantly greater in Asians. For each one unit increase in BMI, Asians were significantly more likely to have hypertension (OR 1.15; 95 % CI 1.13–1.18) compared to non-Hispanic whites, blacks, and Hispanics. Similar trends were seen for diabetes (Asians: OR 1.15; 95 % CI 1.13–1.18). The risk of hypertension in Asians with BMI ≥ 22 was similar to non-Hispanic whites with BMI ≥ 27 and blacks with BMI ≥ 28. The risk of diabetes in Asians with BMI ≥ 28 was similar to non-Hispanic whites with BMI ≥ 30. Despite lower overall BMI compared to other groups, weight gain in Asians is associated with significantly higher risks of hypertension and diabetes. Compared to other ethnic groups, similar risks of hypertension and diabetes are seen in Asians at much lower BMI.