基于胰岛自身抗体阳性与否和有无胰岛β细胞功能残存的Aβ方案在酮症倾向糖尿病临床分型中的应用

Evaluation of islet autoantibodies and β-cell function in classification of patients with ketosis prone diabetes

目的:探讨基于胰岛自身抗体阳性与否和有无胰岛β细胞功能残存的Aβ方案(共有4种组合即A+β+,A+β-,A-β+,A-β-)分型的4种酮症倾向糖尿病(ketosis-prone diabetes,KPD)的临床特点,进一步为KPD的治疗提供临床依据。方法:纳入2000至2010年四川大学华西医院无诱因的自发性酮症或酮症酸中毒住院的初诊糖尿病患者为研究对象,测定其胰岛细胞抗体、胰岛素抗体和谷胺酸脱羧酶抗体。采用空腹C肽评估β细胞功能。结果:共收集134例患者,各组异质性较大,四组患者在体质指数(body mass index,BMI)、腰臀比(waist and hip circumference ratio,WHR)、血糖、糖化血红蛋白(glycosylated hemoglobin A1c,Hb A1c)及甘油三脂(triglyceride,TG)方面差异存在统计学意义(BMI:P=0.000;WHR:P=0.026;血糖:P=0.009;Hb A1c:P=0.001;TG:P=0.044)。两两比较各组之间指标发现A-β+组患者与A-β-组患者之间差异最为明显,前者入院血糖及Hb A1c低于A-β-组患者(血糖:P=0.036;Hb A1c:P=0.010),但BMI、WHR和TG水平明显高于后者(BMI:P=0.005;WHR:P=0.004;TG:P=0.015)。结论:KPD临床特点不同,自身免疫抗体和胰岛β细胞功能差异显著,提示基于胰岛自身抗体阳性与否和有无胰岛β细胞功能残存的Aβ方案可进一步为KPD的治疗提供临床依据。

Objective：To investigate the clinical value of islet autoantibodies（A） and islet β-cell functions（a total of four kinds of combination：A＋β＋,A＋β-,A-β＋,A-β-）in the differential diagnosis and classification in patients with ketosis-prone diabetes（KPD）.Methods：A total of 134 patients with newly diagnosed KPD were included,who were admitted to West China Hospital from January2000 to December 2010. They were divided into four categorical groups based on the presence or absence of autoantibodies（A＋ or A-） and β-cell functional reserve（β＋ or β-）：A＋β＋（n=15）,A＋β-（n=13）,A-β＋（n=77）,A-β-（n=29）. Islet autoantibodies including islet cell antibody,insulin autoantibody and glutamic acid decarboxylase antibody were measured. The clinical characteristics and biochemical parameters were compared among four groups. Results：Of the total 134 patients,there were differences in body mass index（BMI）,waist and hip circumference ratio（WHR）,plasma glucose concentration,glycosylated hemoglobin A1c（Hb A1c） and triglyceride（TG） in four groups（BMI：P =0.000;WHR：P =0.026;blood glucose：P =0.009;Hb A1c：P =0.001;TG：P =0.044）. BMI and WHR were significantly higher in patients of A-β＋ than in patients of A-β-（BMI：P=0.005;WHR：P=0.004）. Plasma glucose concentration and hemoglobin A1c（Hb A1c） of patients in A-β＋ group were lower than those of patients in A-β- group（plasma glucose concentration：P=0.036;Hb A1c：P=0.010）,but the triglyceride levels were significantly higher in A-β＋ group than in A-β- group（P=0.015）.Conclusion：Patients with KPD show significantly different levels of β-cell function,clinical and biochemical characteristics,which may need different therapeutic strategies. Aβ solution based on the autoantibodies（A） and β-cell functional reserve can provide references in the treatment of KPD.