成人隐匿性自身免疫糖尿病患者一级亲属的免疫特征及胰岛功能变化  

Immunological characteristics and islet function in first-degree relatives of latent autoimmune diabetes in adults

作　　者：侯粲[1] 王建平[1] 杨琳[1] 李霞[1] 黄干[1] 周卫东[1] 林健[1] 周智广[1] 

机构地区：[1]中南大学湘雅二医院内分泌科中南大学糖尿病中心,长沙410011

出　　处：《中华医学杂志》2009年第26期1820-1824,共5页National Medical Journal of China

基　　金：国家自然科学基金（30670991）;国家重点基础研究发展计划（2009CB825605,2006CB503901）

摘　　要：目的探讨成人隐匿性自身免疫糖尿病（LADA）患者一级亲属的免疫特征及胰岛β细胞功能变化。方法LADA一级亲属209例，经典1型糖尿病（T1DM）一级亲属340例，行口服葡萄糖耐量试验，观察其临床特征；使用放射配体法检测谷氨酸脱羧酶抗体（GAD—Ab）、蛋白酪氨酸磷酸酶抗体（IA-2Ab），研究其免疫学标志物。对46例一级亲属和39名正常对照进行静脉葡萄糖耐量实验，放射免疫法检测胰岛素，评估其胰岛功能。结果（1）LADA一级亲属GAD—Ab检出率为4．3％（9／209），与经典T1DM一级亲属类似（5．3％，18／340）。（2）LADA一级亲属抗体阳性组第一时相胰岛素分泌及第一时相胰岛素峰值比正常对照组均降低（4．9比5．3，4．1比4．5，P〈0．05）；LADA一级亲属抗体阴性组胰岛素抵抗指数比正常对照组及抗体阳性组增高（（1．41比0．72、0．33，P〈0．05）。（3）LADA一级亲属糖耐量异常（IGT）检出率为16．7％（35／209），糖尿病检出率为10．0％（21／209）。（4）抗体阳性组IGT检出率高于抗体阴性组（37．5％比15．0％，P〈0．05）。结论LADA患者的一级亲属存在一定程度的胰岛自身免疫、胰岛素抵抗及胰岛B细胞分泌功能减退，抗体阳性组糖耐量异常检出率较高。Objective To investigate the immunological features and pancreatic β cell function of first-degree relatives of latent autoimmune diabetes in adults （ LADA ）. Methods Oral glucose tolerance test （OGTF） was performed in 209 first-degree relatives of LADA patients and 340 first-degree relatives of classic T1DM patients. Radioligand assay was used to detect glutamic acid decarboxylase antibody （GAD- Ab） and protein tyrosine phosphatase antibody （IA-2Ab）. Intravenous glucose tolerance tests were performed in 39 normal controls and 46 first-degree relatives. Among them, 9 were GAD-Ab positive and 9 GAD-Ab negative first-degree relatives of patients with LADA while 12 were GAD-Ab positive and 16 GAD-Ab negative first-degree relatives of patients with classic TIDM. Results （ 1 ） Immunological characteristics of first-degree relatives of patients with LADA. Similar with the first-degree relatives of patients with classic T1DM （18/340, 5.3 % ）, the detection rate of GAD-Ab was 4.3% （9/209） in first-degree relatives of patients with LADA. （2） Islet function of first-degree relatives of patients with LADA. Compared with the control group, the first phase insulin release and the first phase insulin peak secretion averages were lower in the antibody positive group of first-degree relatives of patients with LADA（ P 〈 0.05 ） ; HOMA-IR was higher in the antibody negative group of first-degree relatives of patients with LADA （ P 〈 0.05 ）. （ 3 ） Analysis on glucose metabolism of different immune status for first-degree relatives of patients with LADA. （1） The detection rate of impaired glucose tolerance （IGT） was 16.7% （35/209）and diabetes （DM） rate 10.0 % （21/209）. （2） The detection rate of IGT was higher in the antibody positive group than the antibody negative group in first-degree relatives of patients with LADA （ 37.5 % vs15.0% , P 〈 0.05 ）. Conclusions Among first-degree relatives of patients with LADA, a certain extent of islet autoimmune antibod

关 键 词：糖尿病 1型 一级亲属 免疫特征 胰岛功能 

分 类 号：R686[医药卫生—骨科学]