老年T2DM胰岛素治疗患者胰岛素抗体产生情况及风险因素分析

Production and risk factors for insulin antibodies in elderly T2DM patients treated with insulin

目的探究老年2型糖尿病(T2DM)胰岛素治疗患者胰岛素抗体(IA)产生情况,并对其风险因素进行分析。方法选取2020年12月至2022年1月河南科技大学第一附属医院收治的老年T2DM患者156例,所有患者均使用外源性胰岛素并测定IA,依据IA是否阳性分为IA阳性组和IA阴性组,两组患者均行常规血液生化检查,并收集其临床资料,分析T2DM患者IA的风险因素。结果156例T2DM患者,依据IA抗体检测结果,IA阳性32例,阳性率20.51%。IA阳性组和IA阴性组患者的糖尿病病程、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、尿酸(UA)、游离四碘甲状腺原氨酸(FT4)、各时间点胰岛素水平及入院前每日胰岛素剂量比较,差异有统计学意义(P<0.05)。胰岛素治疗患者IA阳性的危险因素分别为糖尿病病程、HDL-C、UA以及空腹胰岛素水平(P<0.05)。受试者操作特征(ROC)曲线分析,病程预测IA阳性的诊断切点为7年(敏感性82.35%,特异性78.46%),HDL-C预测IA阳性诊断切点为1.60 mmol/L(敏感性82.35%,特异性80.00%);UA预测IA阳性诊断切点为369.89μmol/L(敏感性52.90%,特异性95.40%);空腹胰岛素预测IA阳性诊断切点为18.44 mIU/L(敏感性70.59%,特异性89.23%)。结论糖尿病病程、HDL-C、UA以及空腹胰岛素水平均可作为老年T2DM胰岛素治疗患者IA阳性的预测指标。

【Objective】To investigate the production and risk factors for insulin antibodies(IA)in elderly type 2 diabetes mellitus(T2DM)patients treated with insulin.【Methods】A total of 156 elderly T2DM patients admitted to the hospital from December 2020 to January 2022 were selected.The patients were treated with exogenous insulin,and divided into IA positive group and IA negative group.All patients underwent routine blood biochemical examination,and their clinical data were collected to analyze the risk factors for IA in patients with T2DM.【Results】Thirty-two of the 156 T2DM patients were positive for IA,with a positive rate of 20.51%.There were statistically significant differences in the duration of diabetes,HDL-C,LDL-C,UA,FT4,insulin levels at different time points and daily insulin dose before admission between the IA-positive group and the IA-negative group(P<0.05).The duration of diabetes,HDL-C,UA and fasting insulin levels were risk factors for IA in insulin-treated patients(P<0.05).According to ROC curve analysis,the diagnostic cut-off values of the duration of diabetes,HDL-C,UA and fasting insulin level for predicting IA-positive were 7 years(sensitivity 82.35%,specificity 78.46%),1.60 mmol/L(sensitivity 82.35%,specificity 80.00%),369.89μmol/L(sensitivity 52.90%,specificity 95.40%)and 18.44 mIU/L(sensitivity 70.59%,specificity 89.23%),respectively.【Conclusion】The duration of diabetes,HDL-C,UA and fasting insulin levels can be used as predictors of positive IA in elderly T2DM patients treated with insulin.