以酮症起病的糖尿病临床特征分析  

Emergent patients with ketosis-onset diabetes:an analysis of clinical characteristics

作　　者：潘洁敏[1] 包玉倩[1] 张磊[1] 于浩泳[1] 张允平[2] 贾伟平[1] 

机构地区：[1]上海交通大学附属第六人民医院内分泌代谢科,上海市糖尿病临床医学中心,200233 [2]上海交通大学附属第六人民医院急诊科,200233

出　　处：《上海医学》2009年第11期1003-1006,共4页Shanghai Medical Journal

摘　　要：目的了解以酮症起病的糖尿病患者的自身抗体检出情况,并分析其临床特征。方法测定133例以酮症起病的糖尿病患者的血脂谱、随机血糖、糖化血红蛋白、胰岛功能、谷氨酸脱羧酶抗体(GAD-Ab)和蛋白酪氨酸磷酸酶抗体(IA2-Ab),记录血压、体重、糖尿病家族史等。任一自身免疫抗体阳性为A+,两种抗体阴性为A-;空腹C肽≥0.333 nmol/L定为B+,反之为B-。根据检测结果将研究队列分为3组,组1为A+,包括A+B+和A+B-;组2为A-B+;组3为A-B-。结果①GAD-Ab阳性率为27.8%,IA2-Ab阳性率为16.5%,任一阳性占29.3%。②组1的年龄和体质指数(BMI)显著小于组2和组3(P值均<0.01),而随机血糖和高密度脂蛋白胆固醇水平显著高于组2和组3(P值分别<0.05、0.01)。组2的糖尿病家族史伴发率最高,占48.2%。组2的三酰甘油水平显著高于组1(P<0.05),而空腹C肽及餐后2 h C肽水平显著高于组1和组3(P值均<0.01)。结论以酮症起病的糖尿病患者的临床特点存在差异,结合自身免疫抗体和胰岛B细胞功能可提示其临床表型亚型的归类,采取不同的治疗策略。Objective To investigate the presence of islet autoantibodies in patients with ketosis-onset diabetes, and to analyze their clinical characteristics. Methods The lipid profile, random plasma glucose, hemoglobin A1c, pancreatic function and islet auto-antibodies （glutamic acid decarboxylase antibody I-GAD-Abe, protein tyrosine phosphatase antibody r-IA2-Ab~） were examined in 133 diabetic patients with ketosis-onset. The blood pressure, weight and diabetes family history were also recorded. This cohort was divided into three groups based on the presence or absence of auto-antibodies （A＋ or A- ） and B-cell functional reserve （B ＋ or B- ） ： group I, A＋ （includingA＋B＋ andA＋B-）; group 2, A-B＋; group 3, A-B-. Results （1） The positive rates of GAD-Ab and IA2-Ab were 27.8% and 16.5%, respectively, and that of either of the 2 antibodies was 29.3%. （2） The age and body mass index （BMI） of group I were significantly younger and lower than those of group 2 and group 3 （P〈0.01）, while the random plasma glucose and high density lipoprotein cholesterol （HDL- C） of group I were markedly higher than those of group 2 and group 3 （P〈0.05 and 0.01）. There were 48.2% patients in group 2 having a diabetes family history, higher than the other two groups. Group 2 had a higher level of triglyceride （TG） compared with group I （P^0.05）and higher levels of fasting C peptide and postprandial C ／ peptide compared with group I and group 3（P〈0.01）. Conclusion Diabetic patients with ketosis-onset have different clinical characteristics. Auto-antibodies and B-cell functional reserve may help to identify the subtypes of diabetes, leading to different therapeutic strategies. （Shanghai Med J, 2009, 32 .- 1003-1006）

关 键 词：糖尿病 酮症起病 B细胞功能 胰岛自身抗体 

分 类 号：R587.1[医药卫生—内分泌] R587.2[医药卫生—内科学]