新诊断非酮症糖尿病患者胰岛相关自身抗体与甲状腺抗体的相关性研究

Correlation between the islet autoantibodies and thyroid antibodies in patients with newly diagnosed nonketotic diabetes mellitus

目的对新诊断非酮症起病的糖尿病患者进行胰岛相关自身抗体和甲状腺抗体的研究,探讨新诊断糖尿病中胰岛相关自身抗体、甲状腺抗体及功能异常的规律。方法选取2014年3月至2016年4月在我院内分泌科住院的新诊断酮体阴性的糖尿病患者413例为病例组,同期我院健康体检人群347名为对照(NC)组,比较两组胰岛相关自身抗体及甲状腺抗体的阳性率及甲状腺功能,分析胰岛相关自身抗体阳性的临床特点。结果病例组胰岛相关自身抗体阳性率及甲状腺抗体阳性率均高于NC组(9.2%vs 4.6%,32.7%vs 19.6%,P<0.05),且以GADAb和TPOAb为主。两组甲状腺抗体阳性,但甲状腺功能正常的发病率较甲状腺抗体阳性合并甲状腺功能亢进(下称"甲亢")(病例组14.5%vs6.2%,NC组8.9%vs 3.7%)、甲状腺功能减退(下称"甲减")(病例组14.5%vs 11.9%,NC组8.9%vs7.2%)的发病率升高(P<0.05)。两组甲状腺功能异常中亚临床甲减最多,发病率较其他甲状腺功能异常升高(P<0.05)。将病例组中甲状腺功能正常的患者进一步按胰岛相关自身抗体分为阳性亚组和阴性亚组,两亚组女性比例、年龄、BMI、HbA_1c、TG、TC、LDL-C、HDL-C、FC-P、2hC-P、激离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)比较,差异无统计学意义(P>0.05),两组间抗过氧化物酶抗体(TPOAb)阳性率、TSH、2hC-P差异有统计学意义(P<0.05)。结论新诊断非酮症糖尿病患者中存在较高甲状腺抗体阳性率,且以单纯甲状腺抗体阳性但甲状腺功能正常为主,甲功异常中以亚临床甲减为主,所以在甲状腺功能正常的新诊断糖尿病中常规检测抗甲状腺球蛋白抗体(ATG)、TPOAb具有一定意义,可发现更多合并自身免疫性甲状腺疾病的患者。新诊断非酮症糖尿病中胰岛相关自身抗体的阳性率较健康人群高,且胰岛相关自身抗体阳性患者的TPOAb抗体滴度及TSH较高,2hC-P较低,不排除一部分为LADA患者,需进一步继续追踪随访胰岛细胞功能、甲状腺功能。

Objective To explorethe islet autoantibodies and thyroid antibodies in patients with newly diagnosed nonketotic diabetic patients, and to find the characteristics of islet autoantibodies, thyroid antibodies and thyroid dysfunction in newly diagnosed diabetes. Methods A total of 413 newly diagnosed nonketotic diabetic patients in the department of endocrinology in our hospital were enrolled in this study as case group from March 2014 to April 2016. At the same time, 347 cases doing health physical examination inour hospital were selected as control group（NC）. The islet autoantibodies,thyroid antibody positive rate and thyroid function were compared between the two groups. The clinical characteristics of patient with positive pancreatic islet autoantibodies were analyzed. Results The positive rate of islet autoantibodies and the positive rate of thyroid antibody were significantly higher in case group than in NC group（9. 2% vs 4. 6%, 32.7% vs 19.6%, P〈0.05）. GADAb and TPOAb were the most popular antibodies in case group. The incidence rate of thyroid antibody positive plusnormal thyroid function were significantly higher than thyroid antibody positive plus hyperthyroidism （case group 14. 5% vs 6.2%, control group 8. 9% vs 3.7%, P〈0. 05） and thyroid antibody positive plushypothyroidism （case group 14.5 % vs 11.9 %, control group 8.9 % vs 7.2 %, P〈0. 05）. The subclinical hypothyroidism was higher than the other types of thyroid dysfunction in both groups （P〈0. 05）. Patients with normal thyroid function were further divided into two subgroups： islet autoantitxxties positive group and negative group. There were no significant differences in the proportion of women, age, BMI, HbA1 c, TG, TC, LDL-C, HDL-C, FC-P, FT3 ,FT4 ,and TSH between the two subgroups （P〈 0. 05）. There were significant differences in the TPOAb positive rate, TSH, and 2 hC-P between the two subgroups （P〈0.05）. Conclusion There is a high positive rate of thyroid antibody in patients withnewly diagnosed non ketotic diabetes, and thyroid function was normal in most patients. In patients with abnormal thyroid function, subclinical hypothyroidism was common. So in patients with newly diagnosed diabetes with normal thyroid function, measurement of the thyroglobulin antibody and peroxidase antibodyroutinely coulddetect more autoimmune thyroid disease. The positive rate of islet related autoantibodies was higher in patients with newly diagnosed non ketotic diabetesthan in healthy subjects. And islet related autoantibodies positive patients showed higher TPOAb antibody titers, lower 2 hour postprandial C peptide level, and higher TSH level, indicating that islet cell function and thyroid function of those patients may need further follow-up in order to exclude potential LADA.