成人晚发型自身免疫性糖尿病患者非糖尿病子女胰岛细胞抗体的变化

Changes of islet cell antibodies in non-diabetes of fspring of probands with latent autoimmune diabetes mellitus in adults

目的:探讨成人晚发自身免疫性糖尿病(latentautoimmunediabetesmel-litusinadults,LADA)患者非糖尿病子女中胰岛细胞抗体(isletcellan-tibodies,ICA)的检出率及临床意义,为糖尿病的预防、康复干预提供理论依据。方法:2002-06/2003-06邯郸市第一医院内分泌科住院及门诊就诊糖尿病患者总共1236例。纳入标准:均为邯郸市第一医院的门诊和住院患者,诊断符合1999年WHO糖尿病诊断标准,均未长期应用胰岛素治疗,无甲状腺功能亢进等自身免疫性疾病;排除标准:排除长期接受胰岛素治疗的及合并可疑自身免疫性疾病的患者。实际纳入2型糖尿病患者96例(其中ICA检测为阳性的患者计为LADA患者),男55例,女41例。选取上述患者的非糖尿病子女102例为患者子女组,男60例,女42例,纳入标准:经75g口服葡萄糖耐量试验(OGTT)血糖正常;无自身免疫性疾病及其他急慢性疾病。排除标准:有三多一少症状及明确糖尿病诊断或糖耐量异常的,合并可疑自身免疫性疾病的。选取2003-04/06邯郸市第一医院健康体检志愿者35例(男20例,女15例)的健康子女40例为对照子女组,男25例,女15例,纳入标准:OGTT正常。排除标准:可疑糖尿病患者及有糖尿病家族史的,可疑自身免疫性疾病的。采用免疫组化法检测所有受试者血清中的ICA滴度。结果:①2型糖尿病患者中,ICA?

AIM:To investigate the detection rate of islet cell antibodies (ICA) and clinical significance in non diabetes offspring of probands with latent autoimmune diabetes mellitus in adults (LADA), so as to provide theoretical evidence for the prevention and rehabilitative intervention of diabetes mellitus (DM). METHODS:Totally 1 236 inpatients and outpatients with DM were selected from the Department of Endocrinology, First Hospital of Handan City during June 2002 to June 2003. All patients were in accordance with the criteria of the 1999 WHO DM diagnostic standard, and had not been treated with insulin for a long time, they all had no autoimmune disease such as hyperthyroidism. The patients who were treated with insulin for a long time or had doubtful autoimmune disease were excluded. Actually 96 patients with type 2 DM (55 males and 41 females) were involved, those with positive ICA detection were taken as LADA.A total of 102 non DM offspring of the patients were assigned into the offspring group (60 males, 42 females). They all had normal blood glucose according to 75 g oral glucose tolerance test (OGTT) but had no autoimmune disease or other acute and chronic diseases, while those had the symptoms of three excess and once deficiency and were clearly diagnosed to have DM or abnormal glucose tolerance or had doubtful autoimmune disease were excluded. Other 35 healthy volunteers (20 males and 15 female=15) from the First Hospital of Handan City during April to June 2003 were selected, and their 40 healthy offsprings (25 males and 15 females) were taken as the controls, they all had normal OGTT, and those who were doubted to have DM and had DM family history, or had doubtful autoimmune disease were excluded.ICA titres were detected among all the cases with immunohistochemistry. RESULTS: ①Among the patients with type 2 DM, the positive rate of ICA was 21%, and positive ICA could be diagnosed as LADA. ②ICA positive rates for the offsprings of patients with positive ICA (n=24), negative ICA (n=78) and the control group (n=40) were 17%(4/24), 3%(2/78) and 0 respectively.The positive rate of ICA in the offsprings of the DM patients with positive ICA was significantly higher than that in those with negative ICA (χ2=11.5,P< 0.01). CONCLUSION: Routine ICA examination can increase the detection rate of LADA.The LADA offsprings have a higher positive rate of ICA than the offspring of type 2 DM patients, the offsprings with positive ICA are high risk group of LADA.