老年LADA的临床特点分析

Clinical characteristics of senile latent autoimmune diabetes in adults

目的探讨老年起病(≥60岁)成人隐匿性自身免疫糖尿病(LADA)的临床特点.方法采用回顾性分析方法,对2000年～2003年中南大学湘雅二医院内分泌科住院的846例临床初诊为2型糖尿病(T2DM)患者进行谷氨酸脱羧酶抗体(GAD-Ab)检测,分别比较老年LADA(GAD-Ab阳性)与老年T2DM(GAD-Ab阴性),老年LADA与中青年LADA(15～59岁)的C肽、体重指数(BMI)、HBA1c等.GAD-Ab采用放射配体法,C肽测定采用放射免疫法.结果老年LADA占老年初诊2型糖尿病的8.8%(18/204),中青年LADA占中青年初诊2型糖尿病患者的9.3%(60/642),差异无显著性(P＞0.05);老年LADA与老年T2DM比较,C肽、体重指数(BMI)、HBA1c等无统计学差异(P＞0.05);老年LADA与中青年LADA比较,C肽水平较高、BMI较大(P＜0.05).结论老年LADA占老年初诊2型糖尿病的8.8%,其临床特点与老年T2DM相似,需测定GAD-Ab以利早期分型.

Objective: To investigate the clinical characteristics of senile onset (≥60 years old)latent autoimmune diabetes in adults (LADA). Methods: 846 cases of initially diagnosed type 2 diabetes (T2DM), screened by Glutamic acid decarboxylase autoantibodies (GAD-Ab), were analyzed retrospectively in the Second Xiangya Hospital of Central South University from 2000 to 2003. C peptide, BMI, HBA1c etc. were compared between senile LADA and senile T2DM, senile LADA and non-senile LADA (15-59 years old). GAD-Ab and C peptide were measured with radioligand immunoassay and radioimmune assay respectively. Results: No difference in GAD-Ab prevalence was found between senile diabetes (18/204, 8.8%) and non-senile diabetes (60/642, 9.3%); No difference was found in C peptide, BMI, HBA1c between senile LADA and senile T2DM; C peptide level and BMI were higher in senile LADA than non-senile LADA (P <0.05). Conclusions: The prevalence of senile LADA was 8.8% in initially diagnosed senile T2DM, and it was characterized by a similar clinical manifestation to senile T2DM. GAD-Ab screening is necessary for etiological classification in senile diabetes.