成人隐匿性自身免疫糖尿病与2型糖尿病的血管并发症比较

Comparison of vascular complications between adults latent autoimmune diabetes and type 2 diabetes

目的探讨成人隐匿性自身免疫糖尿病（LADA）与2型糖尿病（T2DM）血管并发症（包括微血管病变及相关大血管疾病）的差异。方法比较203例LADA患者与年龄、性别、糖尿病病程及糖尿病家族史匹配的他DM患者24h尿白蛋白、眼底检查或荧光造影、心电图、肌电图、血压、血脂、体质指数、空腹血糖、餐后2h血糖、糖化血红蛋白、C肽等方面的差异。结果①微血管病变：LADA患者较T2DM患者糖尿病肾病的患病率高（39．9％vs．28．6％，P〈0．05），而2组间视网膜病变和周围神经病变的患病率差异无统计学意义（P〉0．05）。②大血管病变：LADA患者较T2DM患者高血压、代谢综合征的患病率低（38．9％vs.55.7％，P〈0．01；33．0％vs．45．3％，P〈0．01），2组间冠心病及脑梗死的患病率差异无统计学意义（均P〉0．05）。结论LADA患者与T2DM患者血管并发症存在差异：LADA患者糖尿病肾病患病率较高，而高血压和代谢综合征的患病率较低。

Objective To compare the prevalence of microvascular and macrovascular complications between adult latent autoimmune diabetes （LADA） and type 2 diabetic subjects. Methods A cross-sectional study was performed in 203 LADA（ GADA positive） and 203 T2DM （ GADA negative ） subjects matched with age,gender and duration as well as family history of diabetes. Parameters of microvascular （ albuminuria,eyeground microscopy or fundus fluorescence photography, electromyogram ） and macrovascular complications （ electrocardiogram, blood pressure,blood lipid,body mass index） as well as blood sugar were compared. Results ①Microvascular complications：Compared with T2DM,LADA cases showed higher prevalence of diabetic nephropathy （39.9% vs. 28.6% , P 〈0.05） and similar prevalence in diabetic neuropathy and retinopathy（ P 〉 0.05）. ②Macrovascular complications： LADA cases presented lower prevalence of hypertension （38.9% vs. 55.7% ,P 〈 0.01 ） , lower prevalence of metabolic syndrome （ 33.0% vs. 45, 3% ,P 〈 0.01 ） , but similar prevalence of coronary heart disease （CHD） and cerebral infarction （ CVD ） （ P 〉 0.05 ）. Conclusion LADA patients present less metabolic syndrome, hypertension and more diabetic nephropathy compared with T2DM.