酮症起病糖尿病患者105例病因分型的临床研究

Clinical characteristics of patients with ketosis-onset diabetes

根据胰岛自身抗体（A）阳性与否和是否保留有胰岛功能（B），将105例酮症起病的糖尿病患者分A＋B-、A＋B＋、A—B-、A—B＋4个组，观察对胰岛素依赖性。A—B＋组非胰岛素依赖占94％（46／49），A—B-组占1／10，而A＋B-组为20％（4／20）、A＋B＋组为58％（15／26）；A—B＋组IL-6水平最低，而肿瘤坏死因子饯水平最高，IL-18水平则A＋B-和A＋B＋组较高。提示酮症起病的糖尿病患者临床特点存在差异，自身免疫抗体和胰岛B细胞功能可提示临床表型亚型的归类，从而采取不同的治疗策略。

A total of 105 patients with ketosis-onset diabetes were divided into four groups （A＋B-, A ＋ B ＋, A - B -, A - B ＋） based on the results of islet-associated aatoantibodies （ A ＋ ,A - ） and p-cell function （ B ＋ ,B - ）. Nearly 94% patients in the A - B ＋ group and 1/10 patients in the A - B - group were non-insulin dependent. While in the A ＋ B - and A ＋ B ＋ groups, the detection rates of subsequent non-insulin dependency were 20% and 58% , respectively. Among the four groups, patients in the A - B ＋ groups had a lower level of IL-6 and a higher level of TNF-α. Patients in the A ＋ B - and A ＋ B ＋ groups had a higher level of IL-18. Our study indicates that patients with ketosis-onset diabetes may present different clinical characteristics. Evaluate the islet-associated autoantibodies and pancreatic β-cell function may be helpful to the clinical diagnostic and therapeutic strategies in diabetes.