成人隐匿性自身免疫性糖尿病漏诊为2型糖尿病的原因分析及干预对策研究  

Study on causes analysis and intervention countermeasures of missed diagnosis of latent autoimmune diabetes in adults as type 2 diabetes mellitus

作　　者：陈思睿 韩亚娟 CHEN Sirui;HAN Yajuan(Department of Endocrinology,Guangzhou Eighth People's Hospital Affiliated to Guangzhou Medical University,Guangdong,Guangzhou 510400,China)

机构地区：[1]广州医科大学附属市八医院内分泌科,广东广州510400

出　　处：《中国医药科学》2021年第19期218-221,共4页China Medicine And Pharmacy

摘　　要：目的探讨成人隐匿性自身免疫性糖尿病(LADA)患者漏诊为2型糖尿病(T2DM)的原因及干预对策。方法采用整群抽样方法,选取广州医科大学附属市八医院内分泌科2018年4月至2020年1月的72例LADA患者为对象,根据患者是否漏诊为T2DM分为漏诊组(n=42)与非漏诊组(n=30)。查阅两组病历资料,统计患者年龄、病程、体重指数(BMI)、糖尿病自身抗体、血脂、胰岛功能、肾功能、尿酮体、眼底检查、颈动脉彩超、用药情况,并完成单因素、多因素logistic分析,针对可能的原因制订相应的干预对策。结果72例LADA患者42例漏诊为T2DM,漏诊率为58.33%。单因素及多因素logistic分析结果表明:LADA漏诊为T2DM与三酰甘油、总胆固醇、低密度脂蛋白、肌酐、肾小球滤过率、尿酮体、眼底检查、颈动脉彩超、用药情况差异无统计学意义(P>0.05);LADA漏诊为T2DM的独立危险因素为:年龄、病程、BMI、糖尿病自身抗体谷氨酸脱羧酶抗体(GAD-Ab)、胰岛细胞抗体(ICA)、胰岛素自身抗体(insulin autoantibody,IAA)、胰岛素自身抗体(ICA)-免疫球蛋白G(IgG)、胰岛功能C肽和胰岛素(P<0.05)。结论LADA患者漏诊为T2DM原因较多,且不同原因可相互作用、相互影响,应根据上述可能的原因采取相应的干预对策,降低临床漏诊率。Objective To investigate the causes and intervention countermeasures of missed diagnosis of Latent autoimmune diabetes in adults(LADA)as type 2 diabetes mellitus(T2DM)in patients.Methods With the cluster random sampling method,72 patients with LADA in the Department of Endocrinology in Guangzhou Eighth People's Hospital Affiliated to Guangzhou Medical University from April 2018 to January 2020 were selected.They were divided into the missed diagnosis group(n=42)and the non-missed diagnosis group(n=30)according to whether they were missed diagnosed as T2DM.The medical records of both groups were checked to count patients'age,course of disease,body mass index(BMI),diabetic autoantibodies,blood lipids,pancreatic function,renal function,urinary ketone bodies,fundusexamination,carotid ultrasound,and medication,and univariate and multifactorial logistic analyses were completed to make appropriate intervention countermeasures for possible causes.Results 42 cases of 72 T2DM patients were missed diagnosed as T2DM,with a 58.33%missed diagnosis rate.The results of univariate and multifactorial logistic analyses showed that there was no statistically significant difference between the missed diagnosis of LADA as T2DM and triglycerides,total cholesterol,low density lipoprotein,creatinine,glomerular filtration rate,urinary ketone bodies,fundus examination,carotid ultrasound,and medication(P>0.05).Meanwhile,The independent risk factor for LADA missed diagnosis of T2DM were:age,course of disease,BMI,diabetic autoantibody glutamic acid decarboxylase antibody(GAD-Ab),isle t cell antibody(ICA),insulin autoantibody(IAA)and islet cell antibody(ICA)-immunoglobulin G(IgG),islet function C peptide and insulin(P<0.05).Conclusion There are many causes for the missed diagnosis of LADA as T2DM in patients,and different causes can interact and influence each other.Therefore,corresponding intervention countermeasures should be taken according to the above possible causes to reduce the clinical missed diagnosis rate.

关 键 词：1型糖尿病 LADA(成人隐匿性自身免疫性糖尿病) 2型糖尿病 原因分析 干预对策 多因素LOGISTIC分析 

分 类 号：R587.1[医药卫生—内分泌]