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 82 0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 2hC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LA DA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。

CLINICAL HETEROGENOUS CHARACTERS OF LATENT AUTOIMMUNE DISEASES IN ADULTS BY COMBINATION OF ICA AND AUTOANTIBODIES TO BLUTAMIC ACID DECARBOXYLASE

Objective\ To probe into clinical heterogeneous characters of patients with LADA in Chinese population.Methods\ Sera of 820 patients with diagnosis of type 2 diabetes mellitus(T2DM) were screen for GAD-Ab/ICA.Three hundred and eleven patients were further studied and divided into subgroups by positive results of GAD-Ab/ICA to compare clinical characters. Results\ (1)A total of 93 GAD-Ab positive patients were identified. The significant difference of distributions of GAD-Ab positive patients was observed among subgroups by age. (2)Compared with the patients with negative GAD-Ab,the patients with positive GAD-Ab had lower age of onset,lower body mass index and fasting postprandial 2 h C peptide, much more ketosis , lower rates of hypertension and hyperlipidemia.(3)Compared\ with the patients in LADA-1 group,the patients in LADA-2 group had worse beta cell function,lower body mass index,much more therapy with insulin , lower rates of hypertension and hyperlipidemia et al, and also have more resemblance to insulin dependent diabetes. Conclusion\ Two clinically distinct type of LADA can be identified by combination with antibodies of GAD-Ab and ICA .