老年糖尿病患者血谷氨酸脱羧酶抗体检测的意义

Significance of detection of glutamic acid decarboxylase autoantibodies in elderly patients with diabetes

目的比较老年糖尿病患者中血谷氨酸脱羧酶抗体(GAD-Ab)阳性者与阴性者其临床特征及生化检测的差异。方法对142例住院老年糖尿病患者进行GAD-Ab检测,将其分为GAD-Ab阳性组(17例)与GAD-Ab阴性组(125例),分别进行血液生化结果及临床特征比较。结果GAD-Ab阳性组的年龄、性别、空腹血糖、餐后2小时血糖、糖化血红蛋白、空腹胰岛素水平、血甘油三酯、胆固醇水平及胰岛素敏感指数与阴性组比较无统计学显著性差异(P>0.05),GAD-Ab阳性组具有较低的空腹C肽水平(P<0.05)。两组合并冠心病、高血压、脑梗塞、尿蛋白/肌酐升高的机率无显著性差异。老年糖尿病患者空腹C肽水平与空腹血糖呈负相关,与甘油三酯水平呈正相关。结论老年1型糖尿病(成人隐匿性自身免疫性糖尿病,LADA)的临床特点与老年2型糖尿病极为相似,GAD-Ab检测对老年LADA的诊断具有重要意义。

Objective To investigate the difference of clinical and biochemical characteristics between the senile latent autoimmune diabetes in adults（ LADA） and elderly type 2 diabetic patients.Methods 142 cases of elderly patients with diabetes screened by glutamic acid decarboxylase autoantibodies （GAD-Ab） were divided into two groups,17 cases in GAD-Ab positive group and 125 cases in GAD-Ab negative group.Blood biochemical detection and clinical characteristics were compared between two groups.Results There were no differences in age、sex、FPG、PBG、HbA1c、fasting insulin 、TG and TC levels 、insulin sensitivity index between the two groups（P〉0.05）.Fasting C peptide levels were lower in GAD-Ab positive group（P〈0.05）.No difference was found in the prevalence of coronary heart disease、hypertension、cerebral infarction and urine Alb/Cr elevation between two groups.There is positive correlation between triglyceride levels and the fasting C peptide levels in senile diabetes patients.There is negative correlation between fasting plasm glucose and the fasting C peptide levels.Conclusion Senile LADA was characterized by a similar clinical manifestation to senile T2DM. GAD-Ab detection is necessary for the diagnosis of senile LADA.