胰岛素强化治疗对老年隐匿性自身免疫性糖尿病胰岛B细胞功能影响研究

目的探讨通过胰岛素强化治疗老年（≥60岁）起病的成人隐匿性自身免疫性糖尿病（LADA）的疗效,并与2型糖尿病及中青年LADA患者进行临床对照研究。方法回顾性分析2001～2008年海南省农垦总医院内分泌科住院的48例氨酸脱羧酶抗体（GADA）阳性老年LADA患者和同期住院的50例GADA阴性的老年2型糖尿病（T2DM）以及40例中青年（25～60岁）LADA的患者,分别比较其空腹C肽、餐后2h C肽水平、体质量指数（BMI）、糖化血红蛋白（HbA1c）、并发症及治疗1年后空腹C肽、餐后2hC肽水平。结果老年LADA患者与2型糖尿病患者比较,C肽、BMI等无统计学差异（P〉0.05）,HbA1c明显升高（P〈0.05）,血糖波动大。与2型糖尿病患者比较,老年LADA患者并发症明显增多,有统计学差异（P〈0.05）。老年LADA患者与中青年LADA患者比较,治疗前空腹C肽、餐后2hC肽水平等无统计学差异,治疗后空腹C肽、餐后2hC肽水平等有统计学差异（P〈0.05）,与2型糖尿病患者比较,治疗后空腹C肽、餐后2hC肽水平等有统计学差异（P〈0.01）。结论针对老年LADA患者建议早期使用胰岛素强化治疗以保护残余的胰岛B细胞功能,有利于改善患者的预后。

Effects of intensified insulin therapy on the function of B-cell of pancreatic islands in elderly patients with latent autoimmune diabetes

Objective To investigate the efficacy of intensified insulin therapy for latent autoimmune diabetes in elderly patients,and to compare with non-elderly patients.Methods The clincal data were retrospectively analyzed in 48 cases of the elderly patients with latent autoimmune diabetes in andults(LADA) (GADA positive) and 50 cases of the senile type 2 diabetes (GADA negative) and 40 cases of non-senile LADA patients(25～60 years old).The levels of FC-peptide,2 h after-dinner C peptide,BMI and HbA1c,and the incidence of complications were analyzed.One year after the treatment,the levels of FC-peptide and 2 h after-dinner C peptide were also analyzed.Results No difference was found in FC peptide and BMI between the senile LADA patients and elderly patients with type 2 diabetes(P>0.05).But the level of HbA1c and frequency of complications were obviously higher in the senile LADA patients than those in elderly patients with type 2 diabetes(P<0.05).There were no significant differences in FC-peptide and 2 h after-dinner C peptide levels between senile LADA patients and non-senile LADA patients before treatment (P<0.05).There were statistical differences in levels of FC-peptide and 2 h after-dinner C peptide between senile LADA patients and senile type 2 diabetes or non-senile LADA patients after a year’s intensified insulin therapy (P<0.05 or P<0.01).Conclusions Senile LADA patients are recommended to receive intensified insulin therapy as early as possible to protect the residual function of B-cell of pancreatic islands (HCBI),and to improve the prognosis.