成人隐匿性自身免疫性糖尿病的临床特点及诊断模型验证

Clinical characteristics of latent autoimmune diabetes in adult and verification of clinical diagnostic model of type 1 diabetes

目的调查吉林省地区病程≤1年的成人糖尿病患者中LADA患者的比例及临床特点,并验证T1DM诊断模型(CODE)。方法选取2015年3月至2018年3月于吉林大学第二医院门诊及住院治疗的、病程≤1年且年龄18~75岁的糖尿病患者397例,检测GADAb,计算其中LADA患者比例,分析其临床特点,并验证CODE。结果397例糖尿病患者中,LADA患者(LADA组)44例(11.08%),T2DM患者(T2DM组)353例。LADA组BMI、FC-P及2 hC-P均低于T2DM组[(22.70±3.70)vs(25.21±3.86)kg/m^2,(0.73±0.59)vs(1.42±1.02)ng/ml,(1.57±1.49)vs(3.31±2.42)ng/ml,P<0.01],有DKA、甲状腺疾病史的比例高于T2DM组(22.7%vs 8.2%,34.1%vs 7.4%,P<0.01)。以CODE-C0>10.80为切点时,诊断LADA特异度和灵敏度分别为98.3%和11.4%;以CODE-C120>10.91为切点时,诊断LADA特异度和灵敏度分别为96.9%和20.5%。结论LADA在病程≤1年的成人糖尿病患者中占11.08%;与T2DM患者比较,LADA患者BMI、FC-P及2 hC-P水平降低,DKA及甲状腺疾病发生率升高。应用CODE验证LADA的特异度和灵敏度差异较大。

Objective To investigate the prevalence and clinical characteristics of newly diagnosed(diabetic duration≤1 year)latent autoimmune diabetes in adult(LADA)in Jilin Province and to verify the clinical diagnostic model of type 1 diabetes mellitus(T1DM).Methods A total of 397 diabetic patients from the clinic and the ward of Endocrinology Department of The Second Hospital Affiliated of Jilin University were enrolled in this study from March 2015 to March 2018.All the patients were 18~75 years old,and with diabetic duration≤1 year.GADAb was tested.The ratio and clinical features of LADA in the new diagnosed adult diabetes were analyzed and the clinical diagnostic model of type 1 diabetes was verified in this cohort.Results There were 44 patients with LADA(11.08%)and 353 patients with T2DM in all the397 patients.The body mass index(BMI),fasting C-peptide(FC-P),and 2 hour postprandial C peptide(2 hC-P)were all lower in LADA group than in T2DM group[(22.70±3.70)vs(25.21±3.86)kg/m^2,(0.73±0.59)vs(1.42±1.02)ng/ml,(1.57±1.49)vs(3.31±2.42)ng/ml,P<0.01].The prevalence of diabetic ketoacidosis(DKA)and thyroid diseases were higher in LADA group than in T2DM group(22.7%vs 8.2%,34.1%vs 7.4%,P<0.01).The specificity and sensitivity for diagnosis of LADA in the cohort with model CODE-C0>10.8 was 98.3%and 11.4%respectively,and with model CODE-C120>10.91 they were 96.9%and 20.5%respectively.Conclusion The prevalence of LADA in newly diagnosed(diabetic duration≤1 year)adult diabetes was 11.08%in our hospital.BMI,FC-P and 2 hC-P were lower in patients with LADA than in patients with T2DM,while the prevalence of DKA and thyroid disease were much higher in patients with LADA than in patients with T2DM.The specificity and sensitivity for diagnosis of LADA with the current clinical diagnosis model of type 1 diabetes in the cohort were still quite discordant.