成人隐匿性自身免疫糖尿病(Latent autoimmune diabetes in adults,LADA)是成年起病的1型糖尿病的一种重要亚型.早在1977年,Irvine等观察到2型糖尿病中胰岛细胞抗体(ICA)阳性者多无肥胖、血浆C肽水平低、易出现继发口服降糖药失效、较...成人隐匿性自身免疫糖尿病(Latent autoimmune diabetes in adults,LADA)是成年起病的1型糖尿病的一种重要亚型.早在1977年,Irvine等观察到2型糖尿病中胰岛细胞抗体(ICA)阳性者多无肥胖、血浆C肽水平低、易出现继发口服降糖药失效、较多伴有自身免疫病.1987年,Kobayashi[1]建议称此类患者为缓慢进展性胰岛素依赖型糖尿病(SPIDDM).在谷氨酸脱羧酶抗体(GAD-Ab)被鉴定为胰岛自身抗体后,1993年Tuomi等[2] 检测并发现了一组成年发病的非胰岛素依赖性糖尿病(NIDDM)患者GAD-Ab阳性,并将其命名为LADA.LADA患者的特点[3]为:①疾病的性质属于自身免疫性,为1型糖尿病;②起病晚,成年出现;③起病方式缓慢,有较长阶段(至少半年)呈非胰岛素依赖状态.1999年,WHO正式定义其为1型糖尿病的亚型.LADA以胰岛β细胞自身免疫损伤为特征,其进展速度不一,β细胞可长期维持一定的功能,也可较快进展为胰岛素依赖.现主张尽早从貌似2型糖尿病(TZDM)中鉴别出LADA并早期治疗,以减轻胰岛自身免疫损害,保护胰岛β细胞功能,从而延缓胰岛素依赖阶段的出现和糖尿病急、慢性并发症的发生.展开更多
Increased plasminogen activator inhibitor-1 (PAI-1) and decreased tissue-plasminogen activator (t-PA) activities lead to impaired fibrinolysis, which is critical for cardiovascular disease. We studied these hemostatic...Increased plasminogen activator inhibitor-1 (PAI-1) and decreased tissue-plasminogen activator (t-PA) activities lead to impaired fibrinolysis, which is critical for cardiovascular disease. We studied these hemostatic factors at fasting state and after an oral fat load in 12 type 2 diabetic and 17 nondiabetic obese adolescents, matched for age, sex, body mass index, and sexual maturation. Plasma PAI-1, t-PA, and glucose as well as serum C-peptide, insulin, total cholesterol, triglyceride, and HDL and LDL cholesterol levels were measured at 0, 2, 4, and 6 h after the fat load. Metabolic responses were expressed as the area under the curve (AUC). PAI-1 activities were signifi-cantly greater in patients than in control subjects fasting, 23.4 ± 2.6 versus 12.9 ± 2.0 U/mL (p < 0.004); AUC, 101.7 ± 12.1 versus 57.6 ± 6.5 U · h-1 · mL-1 (p < 0.003) . Fasting t-PA activities were significantly lower in the patients than in the control subjects (0.8 ± 0.3 versus 6.5 ± 2.7 U/mL; p < 0.001). Triglyceride was the only lipid parameter that was significantly different in the patients than in the control subjects fasting, 1.5 ± 0.2 versus 0.9 ± 0.1 mM (p < 0.05); AUC, 15.7 ± 2.9 versus 7.9 ± 0.6 mmol· h-1· L-1 (p < 0.02) . The PAI-1 activities decreased significantly during the loading tests (p < 0.0001), whereas the t-PA activities did not change. Insulin resistance estimated by the homeostasis model assessment was greater in the patients than in the control subjects (14.4 ± 2.8 versus 4.6 ± 0.7; p < 0.0001). We conclude that elevated PAI-1 and diminished t-PA activities, suggestive of suppressed fibrinolysis, are present in our adolescents with type 2 diabetes; adding another risk factor for cardiovascular disease and acute high fat load does not further negatively affect this suppressed fibrinolysis.展开更多
文摘Increased plasminogen activator inhibitor-1 (PAI-1) and decreased tissue-plasminogen activator (t-PA) activities lead to impaired fibrinolysis, which is critical for cardiovascular disease. We studied these hemostatic factors at fasting state and after an oral fat load in 12 type 2 diabetic and 17 nondiabetic obese adolescents, matched for age, sex, body mass index, and sexual maturation. Plasma PAI-1, t-PA, and glucose as well as serum C-peptide, insulin, total cholesterol, triglyceride, and HDL and LDL cholesterol levels were measured at 0, 2, 4, and 6 h after the fat load. Metabolic responses were expressed as the area under the curve (AUC). PAI-1 activities were signifi-cantly greater in patients than in control subjects fasting, 23.4 ± 2.6 versus 12.9 ± 2.0 U/mL (p < 0.004); AUC, 101.7 ± 12.1 versus 57.6 ± 6.5 U · h-1 · mL-1 (p < 0.003) . Fasting t-PA activities were significantly lower in the patients than in the control subjects (0.8 ± 0.3 versus 6.5 ± 2.7 U/mL; p < 0.001). Triglyceride was the only lipid parameter that was significantly different in the patients than in the control subjects fasting, 1.5 ± 0.2 versus 0.9 ± 0.1 mM (p < 0.05); AUC, 15.7 ± 2.9 versus 7.9 ± 0.6 mmol· h-1· L-1 (p < 0.02) . The PAI-1 activities decreased significantly during the loading tests (p < 0.0001), whereas the t-PA activities did not change. Insulin resistance estimated by the homeostasis model assessment was greater in the patients than in the control subjects (14.4 ± 2.8 versus 4.6 ± 0.7; p < 0.0001). We conclude that elevated PAI-1 and diminished t-PA activities, suggestive of suppressed fibrinolysis, are present in our adolescents with type 2 diabetes; adding another risk factor for cardiovascular disease and acute high fat load does not further negatively affect this suppressed fibrinolysis.
