成人隐匿性自身免疫糖尿病的患病率调查及其与代谢综合征的关系  

Study on prevalence of latent autoimmune diabetes in adults and its relationship with metabolic syndrome

作　　者：周健[1] 马晓静[1] 包玉倩[1] 潘晓平[1] 陆蔚[1] 胡承[1] 项坤三[1] 贾伟平[1] 

机构地区：[1]上海市糖尿病临床医学中心上海市糖尿病研究所上海交通大学附属第六人民医院内分泌代谢科,200233

出　　处：《中华医学杂志》2009年第18期1250-1254,共5页National Medical Journal of China

基　　金：上海市市级医院新兴前沿技术联合攻关项目（SHDC12006101）

摘　　要：目的探讨临床初诊为2型糖尿病患者中成人隐匿性自身免疫糖尿病（LADA）的患病率、临床特点及与代谢综合征（MS）的关系。方法对1711例住院的临床初诊为2型糖尿病患者采用放射配体法测定谷氨酸脱羧酶抗体（GAD—Ab）和酪氨酸磷酸酶蛋白抗体（IA2-Ab）的水平，了解LADA的患病率并分析其临床特征。MS采用中华医学会糖尿病分会的诊断标准。结果（1）临床初诊2型糖尿病患者中LADA患者检出率为6．7％（115／1711），其中GAD—Ab及IA2-Ab的阳性检出率分别为6．0％及2．4％；（2）病程1年内的初诊2型糖尿病患者其LADA检出率为10．4％，明显高于病程〉1年的患者（5．9％，P〈0．01）；（3）LADA检出率与患者的临床特征有关，发病年龄小、体重指数低、餐后C肽水平低及无糖尿病家族史者具有较高的检出率；（4）51．3％的LADA患者至少伴有除高血糖外其他一种代谢异常，其中21．7％的LADA患者存在MS，各代谢异常患病率由高到低均依次为：高血压、血脂异常、超重／肥胖。结论（1）临床初诊为2型糖尿病住院患者中有6．7％为LADA，对这一人群应进行早期正确的分型诊断以指导临床治疗。（2）超过1／5的LADA患者存在MS，提示LADA患者也应注意代谢异常各因素的全面筛查与干预。Objective To investigate the prevalence, clinical features of latent autoimmune diabetes in adults （LADA） from phenotypic type 2 diabetic patients and the relationship between LADA and metabolic syndrome （MS）. Methods Sera from 1711 phenotypic type 2 diabetic patients were screened for glutamic acid decarboxylase antibody （GAD-Ab） and protein tyrosine phosphatase antibody （IA2-Ab） through radioligand assay. The prevalence of LADA and its relation with clinical features were analyzed. Results （1） The prevalence of LADA in phenotypic type 2 diabetic patients was 6. 7% （ 115/ 1711）, the positive frequency of GAD-Ab and IA2-Ab was 6. 0% and 2.4% respectively. （2）The prevalence of LADA from phenotypic type 2 diabetic patients with a duration of diabetes less than 1 year which was much higher than that of patients with a duration over 1 year （ 10. 4% vs 5.9%, P 〈0. 01 ）. （3） The prevalence of LADA was higher in patients with younger age at onset, lower body mass index and lower level of postprandial C peptide and without diabetes family history. （ 4 ） 51.3% of LADA patients were suffered from at least one kind of metabolic disorders besides hyperglycemia, 21.7% of them were with MS. The prevalence from high to low of those metabolic disorders were as follows： hypertension, dyslipidemia, overweight/obesity. Conclusion （ 1 ） 6. 7% of phenotypic type 2 diabetic patients were LADA, of whom early diagnosis of diabetic type should be made to guide clinical therapies. （2） More than 1/5 patients with MS were found in LADA patients, indicating an overall screening and intervention of metabolic disorder factors is important in LADA patients.

关 键 词：糖尿病 谷氨酸脱羧酶 蛋白酪氨酸磷酸酶 自身抗体 代谢综合征 

分 类 号：R686[医药卫生—骨科学]