起始应用胰岛素治疗对成人隐匿性自身免疫性糖尿病患者胰岛功能影响的回顾性分析  

Retrospective analysis about effects of initiating insulin therapy on islet function patients with latent autoimmune diabetes in adults

作　　者：马燕[1] 冯凯[1] 李伟[1] 平凡[1] 赵冬[2] 李玉秀[1] 

机构地区：[1]中国医学科学院北京协和医学院 北京协和医院内分泌科 卫生部内分泌重点实验室,100730 [2]首都医科大学附属北京潞河医院内分泌科,101149

出　　处：《中华全科医师杂志》2016年第5期356-360,共5页Chinese Journal of General Practitioners

摘　　要：目的探讨起始应用胰岛素治疗和口服药物治疗对成人隐匿性自身免疫性糖尿病（LADA）患者残存胰岛功能的影响。方法回顾1981年1月至2014年10月在北京协和医院住院治疗的59例和门诊治疗的11例LADA患者的临床资料，70例患者随诊2次以上，随诊间隔时间在6个月以上。根据起始早期使用胰岛素和口服药将其分为胰岛素组（34例）和口服药组（36例），比较两组年龄、BMI、病程、空腹和餐后2 hC肽、糖化血红蛋白水平等差异。结果诊断糖尿病时胰岛素组患者的年龄显著小于口服药组[（48.9±11.0）与（54.6±10.4）岁，t＝2.049 ，P＝0.045]；口服药组患者合并其他自身免疫性疾病的比例更高[24%（8/34）与47%（17/36），χ^2＝4.275，P＝0.039]；两组空腹和餐后2 hC肽水平在治疗0～12、13～36、37～60个月时比较差异无统计学意义；治疗时间〉60个月时，胰岛素组较口服药组空腹C肽、餐后2 hC肽水平高[空腹C肽：0.25（0.00～0.80）与0.00（0.00～0.60） μg/L，Z＝3.498，P＝0.030；餐后2 hC肽：0.42（0.02～1.20）与0.14（0.02～0.19） μg/L，Z＝3.235，P＝0.001]。住院患者中，10例复查谷氨酸脱羧酶抗体滴度2次以上，均无抗体转阴。胰岛素组与口服药组中住院患者的糖尿病视网膜病变检出率分别为4%（1/26）、28%（8/29），差异有统计学意义（χ^2＝6.179 P＝0.013）。结论病程超过60个月时，于诊断LADA时早期应用胰岛素治疗较应用口服药物治疗1年以上再换用胰岛素治疗患者的残存胰岛功能好，而且有可能降低糖尿病视网膜病变的发生率。Objective To investigate the effects of initiating oral-medication and insulin-treatment to residual islet function in adult patients with latent autoimmune diabetes in adults（LADA）.Methods Fifty nice inpatients and 11 outpatients of LADA were enrolled from the Peking Union Medical College Hospital from January 1981 to October 2014, including 34 cases with initiating insulin therapy and 36 cases with initiating oral medication. Patients were followed up at least twice and with a 6-month interval. The age, body mass index （BMI）, diagnosis time, fasting C peptide （FCP）, 2-hour postprandial C peptide （2 hCP）, glycosylated hemoglobin （HbA1c） were compared between two groups.Results The age of disease onset in insulin-treatment group was significantly lower than that in oral-medication group （t=2.049, P=0.045）. The proportion of patients complicated with other autoimmune diseases in oral-medication group were higher than that in insulin-treatment group [24%（8/34） vs. 47%（17/36）, χ^2=4.275, P=0.039]. The FCP and 2 hCP in insulin-treatment group were significantly higher than those in oral-medication group [FCP： 0.25（0.00-0.80） vs. 0.00（0.00-0.60） μg/L, Z=3.498, P=0.030, 2 hCP： 0.42（0.02-1.20） vs. 0.14（0.02-0.19） μg/L, Z=3.235, P=0.001] on 6 month after treatment; however, there were no significant differences on 6-12 months, 13-36 months or 37-60 months after treatment between two groups. No antibody negative conversion was detected in 10 inpatients, who were reexamined with glutamic acid decarboxylase antibody （GADA） more than twice. The detection rate of diabetes retinopathy was 4%（1/26） in insulin-treatment group and 28%（8/29） in oral-medication group （χ^2=6.179, P=0.013）.Conclusion Initiating insulin therapy at first diagnosis of LADA can protect the residual islet function, and may reduce the rate of diabetic retinopathy.

关 键 词：糖尿病 自身免疫性 成人 胰岛素 抗体 抗谷氨酸脱羧酶 糖尿病并发症 

分 类 号：R587.1[医药卫生—内分泌]