怀化及其周边少数民族地区初诊2型糖尿病患者LADA的患病率调查

Prevalence of latent autoimmune diabetes in adults from newly diagnosed type 2 diabetes patients of Huaihua and surrounding minority areas

目的调查怀化及其周边少数民族地区成人隐匿性自身免疫性糖尿病(LADA)在新诊断2型糖尿病(T2DM)中的患病率,分析LADA的临床特征,研究LADA与T2DM患者临床特征及细胞免疫的差异。方法回顾性分析2015年6月至2017年12月怀化市第一人民医院内分泌科门诊及住院的新诊断2型糖尿病患者420例,根据谷氨酸脱羧酶(CAD)抗体阳性结果,将其分为LADA组和T2DM组,其中LADA组21例[根据抗CAD滴度分为LADAI组(≥180 Units/ml高滴度)和LADA2组(<180 Units/ml低滴度)],T2DM组399例。调查LADA患者的患病率。检测并比较LADA组和T2DM组间BMI,LDL-C、TG、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、空腹C肽(FCP)..餐后2hC肽(2 h-CP).胱抑素C(Cys C)、同型半胱氨酸(Hey)水平,对20例LADA及年龄病程相匹配的20例T2DM患者进行流式细胞术检测CD4^+/CD8^+T细胞亚群比值。观察LADA患者与T2DM患者临床生化特征及细胞免疫层面的差异。结果(1)新诊断T2DM患者中的LADA检出率为5.0%(21/420),汉族与少数民族的LADA检出率差异无统计学意义(5.3%和4.4%)(P>0.05);(2)LADA组患者的C肽水平(FCP和2 h-CP)低于T2DM组(P均<0.05);LADAI组的FCP及2 h-CP水平较LADA2组更低(P<0.05)。T2DM组的BMI、LDL-C高于LADA组,差异有统计学意义(P<0.05)。T2DM组血清中的Cys C,Hey、中性粒细胞/淋巴细胞比值(NLR)水平高于LADA组,差异有统计学意义(P<0.05);(3)LADA组患者T细胞亚群CD4^+/CD8^+T细胞比值高于T2DM组(P<0.05)。结论(1)新诊断汉族及少数民族T2DM患者中均存在相似比例的LADA患者。抗体高滴度LADA较低滴度LADA及T2DM患者体型偏瘦,胰岛功能更差。但较LADA患者,T2DM患者与代谢紊乱更相关,其大血管并发症风险更高。(2)LADA组较T2DM组患者存在更严重的T细胞免疫失衡。

Objective To investigate the prevalence and clinical characteristics of latent autoimmune diabetes mellitus(LADA)in newly diagnosed type 2 diabetes mellitus(T2DM)in Huaihua and its surrounding minority areas,and study the differences of clinical biochemical characteristics and cellular immunity between LADA and T2DM patients.Methods A total of 420 patients with newly diagnosed type 2 diabetes mellitus in the Department of Endocrinology,Huaihua First People's Hospital from June 2015 to December 2017 were retrospectively analyzed.According to the positive results of glutamic acid decarboxylase(GAD)antibody,they were divided into LADA group and T2DM group,21 cases in LADA group and 399 cases in T2D1M group.According to GAD antibody titer,21 LADA patients were divided into LADA1(^180 Units/ml high titer)group and LADA2(<180 Units/ml low titer)group.The prevalence of LADA patients was analyzed.The body mass index(B M I),low-density lipoprotein cholesterol(LDL-C),total glyceride(TG),fasting plasma glucose(FPG),glycosylated hemoglobin(HbAlc),fasting C peptide(FCP),postprandial 2 h C peptide(2 h-CP)and Cystatin C(Cys C),homocysteine(Hey)were measured.The ratio of CD4^+/CD8^+T cell subsets was detected by flow cytometry in 20 patients with LADA and 20 patients with T2DM.The difference of clinical biochemical characteristics and cellular immunity between LADA patients and T2DM patients were compared.Results(1)The detection rate of LADA in newly diagnosed T2DM patients was 5.0%(21/420),but there was no significant difference between Han nationality and minority nationality(5.3%and 4.4%)(P>0.05).(2)The C-peptide level(FCP,2 h-CP)of LADA group was lower than that of T2DM group(P<0.05);the FCP and 2 h-CP levels of LADA1 group were lower than LADA2 group(P<0.05).The BMI and LDL-C in T2DM group were higher than those in LADA group(P<0.05).The levels of Cys C,Hey and neutrophil/lymphocyte ratio(NLR)in T2DM group were higher than those in LADA group(P<0.05).(3)The ratio of CD4^+/CD8^+T cells in LADA group was higher than that in T2DM group(P<0.05).Conclusions(1)There are similar frequency of LADA patients in newly diagnosed Han and minority T2DM patients.(2)Patients with high antibody titer LADA are thinner than those with low antibody titer LADA and T2DM,and their islet function is worse.However,compared with LADA patients,T2DM patients are more related to metabolic disorders,and have a higher risk of macrovascular complications.(3)LADA patients have more severe immune imbalance than T2DM patients.