成人隐匿性自身免疫糖尿病颈动脉内膜中膜厚度与谷氨酸脱羧酶抗体滴度的关系  

The relationship between carotid intima-media thickness and glutamate decarboxylase antibody titer in latent autoimmune diabetes in adults

作　　者：胡宇航[1] 李桢[2] 姜宏卫[3] 马瑜瑾[3] 闫彩凤 牛晓红[5] 李霞[1] 颜湘[1] 周智广[1] HU Yuhang;LI Zhen;JIANG Hongwei;MA Yujin;YAN Caifeng;NIU Xiaohong;LI Xia;YAN Xiang;ZHOU Zhiguang(Department of Metabolism and Endocrinology&Key Laboratory of Diabetes Immunology,Ministry of Education&National Clinical Research Center for Metabolic Diseases,the Second Xiangya Hospital of Central South University,Changsha,Hunan 410011,China;Department of Ultrasound,the Second Xiangya Hospital,Central South University,Changsha,Hunan 410011,China;Department of Endocrinology,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China;Department of Endocrinology,Subei People􀆳s Hospital of Jiangsu Province,Yangzhou,Jiangsu 225001,China;Department of Endocrinology,Heji Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi 046000,China)

机构地区：[1]中南大学湘雅二医院代谢内分泌科糖尿病免疫学教育部重点实验室国家代谢性疾病临床医学研究中心,湖南省长沙市410011 [2]中南大学湘雅二医院超声科,湖南省长沙市410011 [3]河南科技大学第一附属医院内分泌科,河南省洛阳市471000 [4]苏北人民医院内分泌科,江苏省扬州市225001 [5]长治医学院附属和济医院内分泌科,山西省长治市046000

出　　处：《中国动脉硬化杂志》2020年第8期662-667,共6页Chinese Journal of Arteriosclerosis

基　　金：国家科技支撑计划项目(2015BAI12B13);湖南省科技重大专项(2017SK1020)。

摘　　要：目的探讨成人隐匿性自身免疫糖尿病(LADA)患者颈动脉内膜中膜厚度(C-IMT)与谷氨酸脱羧酶抗体(GADA)滴度的关系。方法选取2015年9月至2019年4月参与中南大学湘雅二医院国家代谢性疾病临床医学研究中心LADA临床试验研究的160名患者基线资料。以GADA滴度为界值分为高滴度LADA-1型(GADA滴度≥0.3)和低滴度LADA-2型(0.05≤GADA滴度<0.3)。收集其颈动脉内膜中膜厚度资料及其他临床资料进行横断面分析。结果LADA-2型患者年龄、高血压比例、代谢综合征比例、体质量、体质指数、腰围、臀围、收缩压、舒张压、空腹C肽、HOMA-IR、甘油三酯水平明显高于LADA-1型患者(P<0.05),而胰岛素使用比例明显低于LADA-1型患者(P<0.01)。与LADA-1型患者比较,LADA-2型患者C-IMT增厚者明显增多(P<0.01),且C-IMT增厚更为显著(P<0.001),在校正代谢综合征相关因素后差异仍显著。多元线性回归分析显示,C-IMT与饮酒史呈正相关(P<0.01),与GADA滴度呈负相关(P<0.01)。根据HOMA-IR将患者分为低HOMA-IR组(HOMA-IR≤2.0)和高HOMA-IR组(HOMA-IR>2.0),LADA-1型高HOMA-IR组较低HOMA-IR组C-IMT显著升高(P<0.01),而LADA-2型患者高、低HOMA-IR组无差异。结论GADA低滴度的LADA患者较高滴度患者有更高的动脉粥样硬化风险,该风险与胰岛素抵抗相关。GADA滴度为LADA患者C-IMT增厚的独立影响因素。Aim The purpose of this study was to investigate the relationship between carotid intima-media thickness(C-IMT)and glutamate decarboxylase antibody(GADA)titer in latent autoimmune diabetes in adults(LADA).Methods The data of 160 patients were selected from a randomized controlled clinical trial"Multi-center study of optimized LADA treatment based on protecting isletβ-cell function"(NCT02407899)led by the National Clinical Research Center for Metabolic Diseases of the Second Xiangya Hospital of Central South University from September 2015 to April2019.GADA titer was used as the cut-off value to divide LADA patients into LADA-1(GADA≥0.3)with high titer and LADA-2(0.05≤GADA<0.3)with low titer.C-IMT data and other clinical data were also collected for the cross-sectional study.Results Patients with type LADA-2 had significantly higher age,hypertension ratio,metabolic syndrome ratio,weight,body mass index,waist circumference,hip circumference,systolic blood pressure,diastolic blood pressure,fasting C-peptide,HOMA-IR and triglyceride levels(P<0.05),but lower insulin usage ratio than patients with LADA-1(P<0.01).Compared with patients with LADA-1,patients with LADA-2 had significantly higher percentage of thickened CIMT(P<0.01)and thicker C-IMT(P<0.001).The difference is still significant after adjusting for related factors of metabolic syndrome.Multiple linear regression analysis showed that C-IMT was positively correlated with drinking history(P<0.01)and negatively correlated with GADA titer(P<0.01).The LADA patients were divided into low HOMA-IR(HOMA-IR≤2.0)and high HOMA-IR(HOMA-IR>2.0)groups.LADA-1 patients with high HOMA-IR had significantly increased C-IMT than those with low HOMA-IR.(P<0.01),but there was no difference between LADA-2 patients with low and high HOMA-IR.Conclusion LADA patients with low GADA titer have a higher risk of atherosclerosis than LADA patients with higher GADA titer,and the risk is associated with insulin resistance.GADA titer is an independent factor of C-IMT in LADA patients.

关 键 词：成人隐匿性自身免疫糖尿病 颈动脉内膜中膜厚度 谷氨酸脱羧酶抗体 

分 类 号：R587.1[医药卫生—内分泌]