特发性1型糖尿病的临床特征及其亚型诊断探讨  

Clinical characteristics and diagnostic points of idiopathic type 1 diabetes and its subtypes

作　　者：周智广[1] 张弛[1] 张冬梅[1] 黄干[1] 王建平[1] 林健[1] 

机构地区：[1]中南大学湘雅二医院内分泌科,代谢内分泌研究所,长沙410011

出　　处：《中华糖尿病杂志（1006-6187）》2004年第2期79-85,共7页

基　　金：国家自然科学基金 ( 3 93 70 3 43 );卫生部优秀青年科技人才基金 (Q942 0 );湖南省卫生厅重点科研基金 ( 2 0 0 1 Z0 4);教育部跨世纪人才基金项目 ( 2 0 0 2 48)资助

摘　　要：目的　探讨特发性 1型糖尿病 (T1DM)的临床特征及其不同亚型的诊断要点。　方法　对 14 4例自发酮症起病的糖尿病患者检测谷氨酸脱羧酶抗体 (GAD Ab)、蛋白酪氨酸磷酸酶抗体(IA 2Ab)和胰岛素自身抗体 (IAA) ,根据阳性与否分为A组和B组 ,比较两组的临床特征、生化指标和HLA DQA1、DQB1易感和保护基因频率的差异。其次 ,将B组根据携带HLA DQ易感和保护基因单体型的不同分为有易感无保护 [S(+)P(- ) (B1组 ) ]、有保护无易感 [S(- )P(+) ]、两者皆无 [S(- )P(- ) ]、两者皆有 [S(+)P(+) ]4组 ,并进行比较。然后 ,将不携带HLA DQ易感基因单体型 [S(- ) ]患者根据体质指数 (BMI)分为非肥胖组 (B2组 )和肥胖组 (B3组 )。比较两组间临床特征的差异 ,并进一步将B1、B2、B3组与A组比较。　结果　B组较A组发病年龄大 ,BMI高 ,肥胖百分率高 ,更容易合并高血压 ,酮症程度较轻 ,甘油三酯、空腹和餐后C肽较高 ,2年后停用胰岛素的比例较高 ,携带HLA DQ易感基因的频率低、保护基因频率高。B1、B2、B3组与A组比较 ,A组发病年龄最轻 ,起病时酮症最严重 ,C肽水平最低 ,2年后停用胰岛素比例为 0 % ;B3组发病年龄最大 ,起病时酮症最轻 ,C肽水平最高 ,2年后停用胰岛素的比例约为 70 % ;B1、B2两组临床特征介于A组和B3组之间。?Objective To investigate the clinical characteristics and diagnostic points of idiopathic type 1 diabetes and its subtypes. Methods Firstly, islet autoantibodies,including glutamic acid decarboxylase antibody (GAD-Ab), protein tyrosine phosphate antibody (IA2-Ab) and insulin autoantibody (IAA),were measured in 144 diabetics with an initial onset of unprovoked ketosis or ketoacidosis. The clinical characteristics, biochemical parameters and HLA-DQ genotypes were compared between patients with (group A,n=60 ) and without autoantibodies (group B, n=84 ). Secondly, according to HLA DQA1-DQB1 haplotypes,group B were further divided into four groups,including S(+)P(-) (group B1, n=16 ), S(-)P(+)(n=10), S(-)P(-)(n=28) and S(+)P(+)(n=3). S(+)P(-) were patients with susceptible HLA DQA1-DQB1 haplotypes and without protective ones. S(-)P(+) were those with protective but without susceptible haplotypes. S(-)P(-) were patients who lack the both and S(+)P(+) were those who have the both. The four groups were compared to find if there was any difference between them. Thirdly, we selected the patients whose body mass index (BMI) <25 kg/m 2 as group B2 (n=23) and those ≥25 kg/m 2 as group B3 (n=15) among patients without susceptible haplotypes [S(-)]. The clinical characteristics were compared between group B2 and group B3, to evaluate if there were any difference between group A and groups B1, B2 and B3. Results Compared with group A, patients in group B owned older age at onset, higher BMI, more obese, less severe DKA, higher level of serum triglyceride and C peptide and more often combined with hypertension. After 2-year follow-up, more patients in group B could achieve acceptable glycemic control or even discontinue insulin therapy. Lower frequency of susceptible HLA DQA1-DQB1 haplotypes and higher frequency of protective ones were found in patients in group B than those in group A. Among patients in four groups, group B1, B2, B3 and group A, patients in group A demonstrated the youngest age at onset, most severe D

关 键 词：特发性1型糖尿病 临床特征 亚型 诊断 胰岛素自身抗体 谷氨酸脱羧酶抗体 

分 类 号：R587.1[医药卫生—内分泌]