不同发病年龄的酮症倾向糖尿病患者临床特征及胰岛自身抗体异质性研究  

Heterogeneity of islet autoantibodies and clinical characteristics in ketosis-prone diabetes with different onset age

作　　者：李莉蓉[1] 上官海燕[1] 胡云[1] 沈山梅[1] 黄干[2] 周智广[2] 朱大龙[1] 

机构地区：[1]南京大学医学院附属鼓楼医院内分泌科,南京210008 [2]中南大学湘雅二医院代谢内分泌研究所

出　　处：《中国糖尿病杂志》2010年第11期854-857,共4页Chinese Journal of Diabetes

基　　金：南京市卫生局重点项目(ZKM05045)

摘　　要：目的探讨谷氨酸脱羧酶抗体(GAD-Ab)、蛋白酪氨酸磷酸酶抗体(IA-2Ab)和SOX13抗体(SOX13-Ab)在不同发病年龄的酮症倾向糖尿病(KPD)患者中的分布规律及其与临床特征的相关性。方法250例KPD患者分为不同的发病年龄组(≤12岁,13～18岁,19～44岁,≥45岁),比较各组患者上述三种抗体的分布规律,探讨胰岛自身抗体异质性对KPD患者临床表型的影响。结果 (1)随发病年龄增加,GAD-Ab、IA-2Ab阳性率呈递减趋势,SOX13-Ab阳性率呈递增趋势;其中,儿童(≤12岁)及青少年(13～18岁)发病的KPD患者中GAD-Ab阳性率显著高于IA-2Ab及SO13-Ab阳性率,儿童发病组中GAD-Ab/IA-2Ab双阳性率显著高于成年发病(≥19岁)组(P均<0.05)。(2)儿童及青少年发病者表现为低BMI、低代谢综合征(MS)及低大血管/微血管并发症发生率(病程≤5年);而中老年(≥45岁)发病者具有胰岛功能好、MS发生率高等特点(P均<0.05)。(3)GAD-Ab、IA-2Ab及SOX13-Ab任一阳性的KPD患者中,IA-2Ab/SOX13-Ab双阳性组胰岛功能显著高于其他抗体状态组。结论 KPD患者中GAD-Ab、IA-2Ab及SOX13-Ab的分布具有与发病年龄相关的异质性,这可部分解释不同发病年龄KPD患者临床特征的差异性。Objective To explore the distribution of glutamic acid decarboxylase antibody（GAD- Ab） ,protein tyrosine phosphatase antibody（IA- 2Ab） and SOX13 antibody（SOX13-Ab） in ketosis-prone diabetes（KPD） with different onset age, arid to investigate the onset age-dependent influence of islet antibody heterogeneity on KPD clinical characteristics. Methods The 250 KPD patients were divided into four subgroups with different onset age（≤ 2 years, 13 - 18 years, 19 -44 years, 945 years） , then to compare their clinical characteristics and to analyze the distribution of GAD-Ab,IA-2Ab and SOX13-Ab in the four KPD subgroups. Results Along with the increase of the onset age of KPD, the positive rate of GAD-Ab and IA-2Ab gradually reduced, while the positive rate of SOX13-Ab gradually increased. In the subgroup with onset age ≤Syears, the positive rate of GAD-Ab was significantly higher than that of IA- 2Ab and SOX1a-Ab. The positive rate of GAD-Ab/IA-2Ab in patients with onset age ≤ 12 years was significantly higher than that in patients with onset age≥19 years. Patients with onset age≤18 years were mainly characterized by lower BMI, lower incidences of metabolic syndrome （MS）, mierovascular complications and macrovascular complications. While patients with onset age≥45 years mainly manifested with higher islet 13 cell function and higher incidence of MS. The 13 cell function of patients positive for both IA-2Ab and SOX13-Ab was significantly higher than that of patients with any other antibody status. Conclusions The onset age-dependent heterogeneity of GAD-Ab,IA-2Ab and SOX13-Ab distribution may contribute to the variety of clinical manifestations of KPD patients.

关 键 词：发病年龄 酮症倾向糖尿病 临床特征 胰岛自身抗体 

分 类 号：R587.1[医药卫生—内分泌]