成人隐匿性自身免疫性糖尿病的临床特征分析

Analysis of Clinical Characteristics of Latent Autoimmune Diabetes in Adults

【目的】探讨成人隐匿性自身免疫性糖尿病（LADA）的临床特征。【方法】分析2型糖尿病（T2DM）、经典1型糖尿病（TIDM）、LADA各20例患者的代谢特点及胰岛功能，胰岛自身抗体分布和并发症情况并进行比较。【结果】LADA在体质量指数（BMI）、年龄方面均明显高于TIDM（P〈0．01），而与T2DM之间无显著性差异（P〉0．05）。LADA出现自发酮症的比例显著高于T2DM，但显著低于T1DM（P〈0．01）。LADA患者的LnHOMA—IR明显低于T2DM（P〈0．01）而高于T1DM。LADA患者的LnHO-MA—IS和空腹C肽明显低于T2DM（P〈O．01），与T1DM近似（P〉0．05），餐后2hC肽明显低于T2DM（P〈0．01）而明显高于T1DM（P〈0．01）。LADA患者的IcA和GAD-Ab双抗体阳性率明显低于T1DM（P〈0．01）。LADA患者大血管病变、视网膜病变、糖尿病肾病、冠心病及脑血管病变的发生率明显高于T1DM（P〈0．05），但和T2DM相比无差异（P〉0．05）；高脂血症和高血压的发生率与TIDM相比无差异，但显著低于T2DM（P〈0．05），具有统计学意义。【结论】LADA患者早期临床表现与T2DM非常相似，其临床特点有助于早期诊断，从而早期防止胰岛β细胞功能过早衰竭。

[Objective]To explore the clinical characteristics of latent autoimmune diabetes in adults（LA- DA）. [Methods] The metabolic characteristics, islet function and islet autoantibodies distribution and complications of 20 patients with type 2 diabetes mellitus（T2DM）, 20 patients with classical type 1 diabetes mellitus （T1DM） and 20 LADA patients were analyzed and compared. [Results] BMI and age of LADA patients were markedly higher than those of TIDM patients（ P 〈0.01）, but there was no significant difference between LA- DA patients and T2DM patients（ P 〈0.05）. The incidence of spontaneously ketosis in LADA patients were markedly higher than those in T2DM patients, but markedly lower than those in T1DM patients（ P 〈0.01）. The LnHOMA-IR of LADA patients was obviously lower than that of T2DM patients（ P 〈0.01） and higher than that of TIDM patients. The LnHOMA-IS and fasting c-peptide of LADA patients were obviously lower than those of T2DM patients（ P 〈0.01）, and similar to TIDM patients（ P 〉0.05）, and 2h-postprandial c- peptide was obviously lower than that of T2DM patients（P 〈 0.01）, and obviously higher than that of TIDM patients（ P d0.01）. ICA and GAD-Ab double antibody positive rate of LADA patients was obviously lower than that of TIDM patients（ P 〈0.01）. The incidence rate of large vascular lesions, retinopathy, coronary heart disease and cerebrovascular lesions in LADA patients were obviously higher than those in T1DM patients （ P 〈0.05）, but there was no significant difference between LADA patients and T2DM patients（ P 〈0.05）. There was no significant difference in the incidence of hyperlipidemia and hypertension between LADA patients and T1DM patients. However the incidence of hyperlipidemia and hypertension in LADA patients were markedly lower than those in T2DM patients（ P 〈0.05）, and there was significant difference. [Conclusion] Early clinical manifestations of LADA patients is very similar to those of T2DM patients, and its clinical features are helpful for the early diagnosis and early prevention of premature failure of islet β-cell function.