1型糖尿病患者各发病年龄段胰岛功能短暂缓解期特征及对远期预后的影响

Characteristics of transient remission of islet function and its influence on long-term prognosis in different onset age patients with type 1 diabetes mellitus

目的 观察T1DM患者各发病年龄段胰岛功能短暂缓解期特征,探讨其对远期预后的影响。方法 选取2014年1月至2018年1月于我院内分泌科治疗的新诊断T1DM患者156例,根据发病年龄分为童年组18例、青少年组108例及成年组30例,比较各组胰岛功能短暂缓解情况及随访胰岛功能保留率。结果 青少年组BMI、FC-P、2 hC-P高于童年组(P<0.05);成年组蛋白酪氨酸磷酸酶及锌转运体8抗体阳性率低于童年组(P<0.05);青少年组胰岛功能短暂缓解发生率高于童年、成年组(P<0.05);青少年、成年组胰岛功能短暂缓解持续时间低于童年组(P<0.05);青少年组发病1年和4年胰岛功能保留率高于童年、成年组(P<0.05)。广义估计方程分析显示,青少年组远期FC-P、2 hC-P高于童年、成年组(P<0.05);成年组既往短暂缓解患者FC-P、2 hC-P高于童年组(P<0.05)。结论 T1DM青少年患者更易出现胰岛功能短暂缓解,童年患者胰岛功能短暂缓解时间更长;胰岛功能短暂缓解人群中以成年患者远期胰岛功能最佳。

Objective To investigate the characteristics of transient remission of islet function and its influence on long-term prognosis in different onset age patients with type 1 diabetes mellitus(T1DM).Methods 156 newly diagnosed T1DM patients who received treatment and completed follow-up were retrospectively chosen from January 2014 to January 2018.All patients were grouped according to the onset age including childhood group(n=18),adolescent group(n=108),adult group(n=30).The transient remission and retention rate of islet function of three groups were compared.The relationship between onset age and c-peptide level was analyzed.Results BMI,FC-P,and 2 hC-P levels in adolescent group were higher than those in childhood group(P<0.05).The positivity rates of protein tyrosine phosphatase and zinc transporter 8 antibodies in adult group were lower than those in childhood group(P<0.05).The incidence of transient remission of pancreatic function in adolescent group was higher than that in childhood and adult groups(P<0.05).The duration of transient remission of pancreatic function in adolescent and adult groups was lower than that in childhood group(P<0.05).The islet function retention rates in adolescent group after 1 and 4 years from onset were higher than those in childhood and adult groups(P<0.05).Generalized estimation equation analysis showed that the long-term FC-P and 2 h C-P in adolescent group were higher than those in childhood and adult groups(P<0.05).The FC-P and 2 h C-P levels in adult patients with previous transient remission were higher than those in childhood group(P<0.05).Conclusions Adolescent onset T1DM patients are more likely to have transient remission of islet function,while childhood onset patients have longer transient remission of islet function.In addition,the adult T1DM patients had the best long-term islet function in transient remission population.