新诊断1型糖尿病患者胰岛功能及其影响因素的临床研究

Evaluation and correlates of β-cell function in patients with newly-onset type 1 diabetes mellitus

目的:探讨新诊断1型糖尿病患者胰岛功能水平及其影响因素。方法 :选取2010年1月—2015年12月在南京医科大学第一附属医院内分泌科住院治疗的新诊断1型糖尿病患者105例,测糖化血红蛋白、胰岛自身抗体及HLA-A和-DR位点,控制血糖<10 mmol/L后行混合餐试验,测血糖、胰岛素及C肽,计算峰值C肽≥0.2 nmol/L的比例,并采用Logistic回归分析影响新诊断1型糖尿病患者胰岛功能的因素。结果:89.5%的患者初诊时峰值C肽≥0.2 nmol/L。初诊年龄≤18岁(OR=0.08,95%CI:0.01~0.90),酮症或酮症酸中毒起病(OR=0.08,95%CI:0.01~0.83),携带高危HLA-A-DRB1基因单倍型(OR=0.07,95%CI:0.01~0.61),胰岛自身抗体阳性数>2(OR=0.10,95%CI:0.01~0.87)者峰值C肽≥0.2 nmol/L率更低。结论 :1型糖尿病患者初诊时仍有部分胰岛功能。因此,胰岛功能不能作为鉴别诊断1型或2型糖尿病的唯一依据。新诊断1型糖尿病患者胰岛功能与初诊年龄、酮症或酮症酸中毒起病、HLA-A-DRB1基因单倍型及胰岛自身抗体有关。

Objective： To describe the levels of residual β-cell function in patients with newly-onset type 1 diabetes mellitus, and investigate factors that may be related. Methods： Data obtained from 105 newly-onset hospitalized type 1 diabetes mellitus patients in the First Affiliated Hospital of Nanjing Medical University from 2010 to 2015. Hemoglobin A1c, islet autoantibodies and HLA-A-DR haplotypes were tested. Mixed-meal tolerance test was carried out until the fasting blood glucose was lower than 10 mmol/L; blood glucose, insulin and C-peptide were measured during the test. The rates of peak C-peptide ≥ 0.2 nmol/L were calculated and logistic regression analyses were performed to explore the influence factors. Results：Eighty-night point five percent of patients had peak C-peptide ≥ 0.2 nmol/L. Logistic regression analyses suggested that factors including age of onset ≤18（OR 0.08,95% CI 0.01-0.90）,diabetic ketosis or ketoacidosis onset（OR 0.08,95% CI 0.01-0.83）,High-risk HLA-A-DRB1 haplotypes（OR 0.07,95% CI 0.01-0.61）,counts of islet autoantibodies 〉2（OR 0.10,95% CI 0.01-0.87） were related to lower rates of peak C-peptide ≥ 0.2 nmol/L. Conclusion： We found that residual β-cell function exists in patients with newly-onset type 1 diabetes mellitus. These data reinforce the inadvisability of using C-peptide alone to differentiate between type 1 diabetes mellitus and other forms of diabetes. We also found that age of onset, diabetic ketosis or ketoacidosis onset, HLA-A-DRB1 haplotypes and islet autoantibodies were associated with β-cell function in patients with newly-onset type 1 diabetes mellitus.