不同亚型1型糖尿病患者大血管病变临床特征及危险因素分析  

Clinical characteristics and risk factors of macrovascular diseases in patients with different subtypes of type 1 diabetes mellitus

作　　者：王丽婷 许岭翎[1] 李伟 平凡 张化冰 马亚红 李玉秀[1] WANG Liting;XU Lingling;LI Wei;PING Fan;ZHANG Huabing;MA Yahong;LI Yuxiu(Department of Endocrinology,Key Laboratory of Endocrinology of National Health Commission,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730;Department of Endocrinology,the First Hospital of Lanzhou University,Lanzhou 730000;Department of Endocrinology,Beijing Puren Hospital,Beijing 100062,China)

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国家卫生健康委员会内分泌重点实验室,北京100730 [2]兰州大学第一医院内分泌科,甘肃兰州730000 [3]北京市普仁医院内分泌科,北京100062

出　　处：《基础医学与临床》2023年第8期1284-1288,共5页Basic and Clinical Medicine

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-12M-C&T-B-003)。

摘　　要：目的探讨不同亚型1型糖尿病(T1DM)患者临床特征以及发生大血管病变的风险。方法回顾性分析2002年3月至2021年7月在北京普仁医院内分泌科就诊的79例T1DM患者的临床资料。其中特发性21例,自身免疫性58例。排除数据缺失者14例,再将其中65例患者分为T1DM大血管病变组(13例)及无大血管病变组(52例)。结果1)与自身免疫性T1DM患者相比,特发性患者病程长,高密度脂蛋白胆固醇(HDL-c)高,体质量指数(BMI)、糖化血红蛋白(HbA1c)、空腹C肽(FC-P)低。2)与无大血管病变组相比,大血管病变组年龄高,特发性T1DM比例大,肾小球滤过率(eGFR)水平、起病时酮症酸中毒(DKA)发生率更低。3)相关分析显示,大血管病变与年龄、病程呈正相关(r值分别为0.432、0.245,P值均<0.05),与eGFR、胰岛自身抗体阳性、起病时DKA发生率呈负相关(r值分别为-0.392、-0.268、-0.313,P值均<0.05)。4)多因素回归分析显示,校正年龄、病程、BMI、eGFR、HDL-c、起病时DKA发生率等混杂因素后,自身抗体阴性是发生大血管病变的危险因素(OR=0.03,95%CI:0.001-0.858,P<0.05)。结论特发性T1DM患者发生大血管病变的风险较自身免疫性T1DM增加。Objective To investigate the clinical characteristics of different subtypes of type 1 diabetes mellitus(T1DM)patients and to analyze the risk of macrovascular diseases in different subtypes of T1DM patients.Methods The clinical data among 79 T1DM patients who treated in the Endocrinology Department of Beijing Puren Hospital from March 2002 to July 2021 were retrospectively analyzed.There were 21 patients with idiopathic T1DM and 58 patients with autoimmune T1DM.Excluding 14 patients because of data missing,65 patients were divided into macrovascular disease group(n=13)and non-macrovascular disease group(n=52).Results 1)Patients with idiopathic T1DM manifested a longer diabetic course,a higher high density lipoprotein cholesterol(HDL-c)level,a lower body mass index(BMI),hemoglobin A1c(HbA1c)and fasting C peptide(FC-P)level.2)Compared with the group non-macrovascular disease,the macrovascular disease group was elder with higher prevalence of idiopathic T1DM and lower estimated glomerular filtration rate(eGFR)level and incidence of diabetic ketoacidosis(DKA)at the beginning of disease.3)Macrovascular lesions were positively correlated with age(r=0.432)and diabetic course(r=0.245)(P<0.05),were negatively correlated with eGFR(r=-0.392),positive islet autoantibody(r=-0.268)and DKA incidence at the beginning of disease(r=-0.313)(P<0.05).4)Multivariate regression analysis showed that negative auto-antibody finding was a risk factor for macrovascular disease(OR=0.03,95%CI:0.001-0.858,P<0.05)after age,diabetic course,BMI,eGFR,HDL-c and incidence of DKA at onset were adjusted.Conclusions Patients with idiopathic T1DM show a higher risk of macrovascular disease risk than those with autoimmune T1DM.

关 键 词：1型糖尿病 大血管病变 特发性 自身免疫性 胰岛自身抗体 

分 类 号：R587.1[医药卫生—内分泌]