初诊成人自身免疫性糖尿病心血管疾病风险评估

Evaluation of the cardiovascular disease risk in newly diagnosed adult with latent autoimmune diabetes

目的:临床评估初诊成人隐匿性自身免疫糖尿病(Latent autoimmune diabetes in adults,LADA)心血管疾病风险。方法:初诊糖尿病(Diabetes mellitus,DM)患者,共132例,经糖尿病自身抗体检测后分为LADA组和2型糖尿病(Type 2diabetes mellitus,T2DM)组(其中LADA组60例,T2DM组72例)。同时从体检中心选取与LADA组年龄、体重指数相匹配的健康对照(Normal controls,NC)组46例。观察高敏C反应蛋白(High-sensitivity C-reactive protein,hs-CRP)水平和颈动脉内膜中层厚度(Carotid intima medial thickness,CIMT),比较三组患者之间的hs-CRP、CIMT水平。结果:1.hs-CRP、CIMT水平在LA-DA组显著高于NC组(P<0.01,P<0.05),LADA不伴动脉硬化(Atherosclerosis,AS)组与NC组比较,hs-CRP、CIMT水平升高达统计学差异(P<0.05)。应用hs-CRP水平进行心血管疾病风险分层后,LADA组与NC组比较,心血管疾病风险中、高危组比例明显升高(P<0.001)。2.将hs-CRP、CIMT水平分别在LADA组和T2DM组之间、LADA不伴AS组和T2DM不伴AS组之间比较,未达统计学差异(P>0.05)。LADA组与T2DM组比较AS发生率差异未达统计学意义(P=0.489)。AS斑块发生率在LADA组、T2DM组两组间比较未见统计学差异(P=0.920)。LADA组与T2DM组hs-CRP危险分层,心血管疾病风险中、高危组比较均未见统计学差异(P>0.05,P>0.05)。3.LADA组中,CIMT与LDL-C、FPG、2hPG、HbA1c、hs-CRP均呈显著直线正相关(P=0.001～0.044)。结论:初诊LADA患者hs-CRP、CIMT水平升高,提示心血管疾病风险增加;与初诊T2DM比较心血管疾病风险无显著差异。

Objective：To investigate the cardiovascular disease risk of the newly diagnosed adult latent autoimmune diabetes （LADA）. Methods：After determination of diabetes autoantibodies, 132 cases newly diagnosed diabetes were divided into LADA group （n = 60） and type 2 diabetes mellitus （T2DM） group （n = 72）. At the same time,46 cases from physical examination center were se-lected in normal controls group （NC group） , whoes age and body mass index matched with LADA group. The high-sensitivity C-reac-tive protein （hs-CRP） level and the carotid intima medial thickness （CIMT） in three groups were compared. Results：l. The concen-tration of hs-CRP and the levels of CIMT in the LADA group was significantly higher than NC group, （P 〈 0.01, P 〈 0.05 ） , and in LADA without atherosclerosis （AS） group also higher than NC group （ P 〈 0.05 ）. The risk stratification of cardiovascular disease u-sing the levels of hs-CRP, the percentage of moderate risk group and high risk group in the LADA group was markedly elevated than NC group（ P 〈 0. 001, P 〈 0.001 ）. 2. Through compared the levels of hs-CRP and CIMT, there were no significant difference between LADA group and T2DM group （P 〉 0.05 ）, also were between LADA without AS group and T2DM without AS group（ P 〉 0. 05 ）. There were no statistical significance between LADA group and T2DM group in the incidence of AS and carotid atherosclerosis plaque（ P = 0. 489, P = 0.920） , the proportion of moderate risk group and high risk group of cardiovascular disease between two group were also no significant difference（P 〉0.05, P 〉0.05）. 3. In LADA group, LDL-C, FPG, HbAlc, 2hPG, hs-CRP showed a significant linear correlation with CIMT（ P = 0. 0014）. 044 ）. Conclusion：The elevated hs-CRP levels and CIMT levels in newly diagnosed LADA indica-ted that its risk of cardiovascular disease was increased. The hs-CRP and CIMT levels in newly diagnosed LADA and newly diagnosed T2DM was no significant difference .