摘要
目的
探讨影响新诊断年轻1型糖尿病患者病程进展后残余β细胞功能(RBF)的预测因素。
方法
入选110例12~35岁起病的新诊断1型糖尿病患者进行(35.1±13.8)个月的临床随访研究。记录一般资料,进行口服葡萄糖耐量试验和C肽释放试验,检测血清学指标、HbA1C和抗谷氨酸脱羧酶抗体(GAD)水平,并进行人类白细胞抗原(HLA)-Ⅱ类基因分型。根据随访终点的C肽峰值(Cmax)是否≥0.6 ng/ml将患者分成高RBF组和低RBF组。建立logistics回归模型分析预测RBF的相关因素。
结果
在随访终点,高RBF组的Cmax水平显著高于低RBF组[(1.87±1.35对0.23±0.19)ng/ml, P〈0.01],HbA1C更低[(7.00±1.69对8.39±1.77)%, P〈0.01],胰岛素剂量显著减低[(0.62±0.17对0.79±0.17)IU·kg-1·d-1,P〈0.01]。Logistics回归提示影响低RBF的相关因素有:起病年龄(OR=0.82,95%CI 0.73~0.92, P=0.001)、HLA-Ⅱ高危表型(OR=4.73,95%CI 1.28~17.52, P=0.020)、女性(OR=3.39,95%CI 1.03~11.22, P=0.045)、糖尿病酮症酸中毒起病史(OR=8.71,95%CI 2.31~32.83, P=0.001)以及病程进展中的HbA1C水平(OR=2.46,95%CI 1.47~4.11, P=0.001)。与血糖控制水平相比,起病状态的相关危险因素(起病年龄〈18岁、女性、携带高危的HLA表型、糖尿病酮症酸中毒起病)的综合预测概率值更大[(OR=145.75,95%CI 17.30~1 228.31, P〈0.01)对(OR=1.82,95%CI 1.24~2.69, P=0.003)]。
结论
起病年龄小、女性、HLA-Ⅱ的高危表型、糖尿病酮症酸中毒起病史和病程中血糖控制不佳是较长病程后低RBF的影响因素;且相比于病程中HbA1C水平,起病状态对残余β细胞功能的影响作用更大。
Objective To investigate the predictive factors of residual β-cell function in young patients with newly-diagnosed type 1 diabetes mellitus. Methods After an average follow-up of ( 35.1 ± 13.8 ) months, a total of 110 young patients with type 1 diabetes mellitus were analyzed. At baseline and follow-up, oral glucose tolerance test (OGTF) and C-peptide release test were carried out, the levels of HbA1c, glutamie acid decarboxylase-antibody ( GAD ), and the genetic polymorphisms of human leukocyte antigen ( HLA ) - Ⅱ were detected. The patients were divided into two groups: high-residual 13-cell function group ( high-RBF group) and low-residual β-cell function group (low-RBF group) , which were defined as stimulated C-peptide ( Cmax ) ≥ 0. 6 ng/ml and 〈0.6 ng/ml at endpoint, respectively. Logistic regression analyses were performed to explore the factors that influence long-term residual β-cell function. Results Compared with low-RBF group, Cmax levels were higher [ ( 1.87 ± 1.35 vs 0. 23 ±0.19 ) ng/ml, P〈0. 01 1, HbA1c levels were lower [ (7.00 ± 1.69 vs 8.39 ± 1.77 ) %, P 〈 0.01 ], insulin dosages were lower [ (0.62 ± 0.17 vs 0. 79 ± 0.17 ) IU · kg^-1 · d^-1 , P 〈0.01 ] in high-RBF group at endpoint. Logistic regression analysis suggested that factors including age of onset (years) [ OR = 0. 82, 95 % CI 0 73-0.92, P = 0. 001 ] , higher HLA risk status ( OR=4.73,95% CI 1.28-17.52, P=0. 020), female sex ( OR=3.39, 95% CI 1.03-11.22, P= 0. 045 ), diabetic ketoacidosis history at onset ( OR = 8.71, 95% CI 2.31-32.83, P = 0. 001 ), and higher mean HbAlc levels ( OR=2.46, 95% CI 1.47-4.11, P=0. 001 ) were related to low residual β-cell function. Compared with mean HbAlc level during diabetes course, predicted probability value for the four baseline factors ( diagnosis age, HLA risk status, gender, and diabetic ketoacidosis history) as the onset state of type 1 diabetes patients was higher [ ( OR = 145.75,95% CI 17.30-1 228.31, P〈0.01 ) vs ( OR = 1. 82, 95% CI 1.24-2.69, P = 0.003 ) ]. Conclusion Younger age of onset, female, higher HLA risk status, diabetic ketoacidosis history at onset and poor glyeemic controlduring diabetes course were the predictive factors of low residual β-cell function in the development of the disease. Compared with mean HbA1c level during diabetes course, an onset state of type 1 diabetes mellitus patients is more valuable to predict long-term residual β-cell function.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2016年第9期728-733,共6页
Chinese Journal of Endocrinology and Metabolism