成人隐匿性自身免疫糖尿病与代谢综合征的关系

目的 探讨成人隐匿性自身免疫糖尿病(LADA)与代谢综合征(MS)的关系及伴有MS的LADA患病率及临床特征。方法 对598例临床初诊为2型糖尿病(type 2 diabetes mellitus,T2DM)的患者用放射配体法测定谷氨酸脱羧酶抗体(glutamic acid decarboxylase autoantibody,GADA),筛查出GADA阳性的LADA和GADA阴性的T2DM患者。比较两组及LADA亚型各组间伴发或不伴发MS的患病率及LADA患者的临床特点。结果 23．7％(22／93)的LADA患者伴有MS;在伴有MS的糖尿病患者中LADA占10．0％,其中约95％为低GADA滴度的LADA-2型;与伴有MS的LADA患者相比,不伴有MS的LADA更类似经典的1型糖尿病,具有低体重、易发生酮症、多依赖胰岛素治疗及胰岛功能较差等特点。结论 23．7％的LADA患者存在MS;伴有和不伴有MS的LADA患者的临床特点不同,且其GADA水平(反映自身免疫破坏程度)差异显著,提示不同特点的LADA患者需要不同的治疗措施。

Metabolic syndrome and latent autoimmune diabetes in adults

To investigate the prevalence of metabolic syndrome(MS)in latent autoimmune diabetes in adults(LADA)and to study the positivity of glutamic acid decarboxylase autoantibody(GADA)in diabetic patients with MS. Methods Sera of 598 patients with an initial diagnosis of type 2 diabetes (T2DM)were screened for GADA with radioligand assay. These patients were divided into LADA andT2DM groups according to the titers of GADA to compare the prevalence of MS; the proportions of LADA in diabetic patients with and without MS were studied. We also compared the clinical charac-teristics of LADA patients with and without MS. Results About 23.7% of the LADA patients had MS. In patients with MS, the prevalence of LADA was 10.0%, of which approximately 95% had low GADA titers, that was, belonging to LADA-type 2. Compared with LADA patients with MS, LADA without MS were similar to classical type 1 diabetes and had features of low body weight, tendency to develop ketosis and impaired islet cell function. Conclusion About 23.7% patients with MS are found in LADA patients. The GADA levels in LADA patients with and without MS are significantly different, which may need different therapeutic strategies.