口服降糖药控制不佳的2型糖尿病患者糖化血红蛋白指数与胰岛素抗体阳性相关性的研究

Correlation between glycated hemoglobin index and insulin antibody positive in type 2 diabetes mellitus patients with poor oral hypoglycemic control

目的探讨口服降糖药控制不佳的T2DM患者糖化血红蛋白指数(HGI)与IAA阳性的相关性。方法选取2020年1月至2021年12月于海口市骨科与糖尿病医院内分泌科治疗、口服降糖药控制血糖不佳而接受Ins治疗的T2DM患者260例,分为IAA阳性组(n=75)和IAA阴性组(n=185)。比较两组一般资料及生化指标,分析IAA阳性与其他生化指标的相关性。结果IAA阳性组FPG、FIns、SUA、HGI、Ins用量、Ins治疗时间>2年患者高于IAA阴性组(P<0.05或P<0.01),HbA1c≥9%患者占比低于IAA阴性组(P<0.01)。IAA阳性组高HGI占比高于IAA阴性组(P<0.05)。Spearman相关分析显示,IAA阳性与HGI呈正相关(P<0.01),与SUA、HDL-C呈负相关(P<0.01)。Logistic回归分析显示,Ins治疗时间、FIns、FPG、SUA、HbA1c、HGI是T2DM患者IAA阳性的影响因素。受试者工作特征曲线分析显示,HGI预测IAA阳性的曲线下面积为0.854,HGI最佳临界值为0.4%,敏感度为83.2%,特异度为79.3%。结论口服降糖药控制不佳的T2DM患者HGI对IAA阳性有预测价值,高HGI与IAA阳性率呈正相关。

Objective To analyze the correlation between glycated hemoglobin index(HGI)and insulin antibody(IAA)positivity in type 2 diabetes mellitus(T2DM)patients with poorly controlled oral hypoglycemic agents.Methods A total of 260 T2DM patients with poor control of oral hypoglycemic agents and receiving insulin treatment in the Department of Endocrinology of Orthopedics and Diabetes Hospital of Haikou City from January 2020 to December 2021 were selected and divided into IAA positive group(n=75)and IAA negative group(n=185).Clinical data and biochemical indicators of the two groups were compared and analyzed the correlation between IAA positivity and other indicators.Results IAA positive group had a higher proportion of patients with insulin high dosage,insulin treatment time>2 years,and higher FIns,FPG,SUA and HGI than IAA negative group(P<0.05 or P<0.01),HbA1c≥9%lower than IAA negative group(P<0.01).Spearman correlation analysis showed that IAA positive was positively correlated with HGI(P<0.01),and negatively correlated with SUA and HDL-C(P<0.01).Logistic regression analysis showed that insulin treatment time,FIns,FPG,SUA,HbA1c and HGI were the influencing factors for IAA positive in T2DM patients.Receiver operating characteristic curve analysis showed that the area under the ROC curve for predicting IAA positive by HGI was 0.854,the optimal critical value for HGI was 0.4%,with the sensitivity 83.2%and the specificity 79.3%.Conclusion In T2DM patients with poorly controlled oral hypoglycemic drugs,high HGI has predictive value for IAA positivity.