【摘要】 为加强临床医师对成人晚发自身免疫性糖尿病（ＬＡＤＡ）的认识，本研究比较了ＬＡＤＡ２５例、胰岛素依赖型糖尿病５７例（儿童发病２１例、成人酮症发病３６例）、非胰岛素依赖型糖尿病３８例（轻至中度３０例、重度８例）及正常人４２例的临床、空腹血糖、血浆Ｃ肽水平及ＨＬＡ－ＤＱＡ１、－ＤＱＢ１链基因频率，提出ＬＡＤＡ的特点及诊断要点为：（１）２０～４８岁发病，发病时多饮、多尿、多食症状明显，体重下降快，体重指数（ＢＭＩ）≤２５，空腹血糖≥１６．５ｍｍｏｌ／Ｌ；（２）空腹血浆Ｃ肽≤０．４ｎｍｏｌ／Ｌ，早晨空腹１００ｇ馒头餐后１小时或（和）２小时Ｃ肽≤０．８ｎｍｏｌ／Ｌ；（３）谷氨酸脱羧酶抗体阳性；（４）ＨＬＡ－ＤＱＢ１链第５７位点为非天门冬氨酸纯合子基因（易感基因）。第（１）点是基本临床特点，加上第（２）、（３）、（４）点中任何一点就考虑诊断ＬＡＤＡ，尽早采用饮食、运动及胰岛素治疗，使空腹及三餐后血糖、糖化血红蛋白（ＨｂＡ１ｃ）控制到正常水平，以保护受自身免疫破坏的胰岛Ｂ细胞功能，有利于防止糖尿病眼、肾、神经并发症。更多还原

【Abstract】 To understand latent autoimmune diabetes mellitus in adults (LADA), we compared the clinical characteristics, fasting plasma glucose and C peptide level, genetic frequency of HLA DQA1, DQB1 chain in 25 patients with LADA, 57 patients with insulin dependent diabetes mellitus (IDDM, 21 patients with children onset IDDM, 36 patients with adult onset IDDM with ketosis), 38 patients with NIDDM (mild and moderate 30 patients and severe 8) and 42 normal persons. The onset of age was 20～48 years old associated with obvious polyphagia, and weight loss. Body mass index (BMI) was ≤25 and fasting plasma glucose was ≥16.5 mmol/L (297mg/dl). Fasting and 1, 2 hour post prandial C peptide level showed low and flatter curve (0.4, 0.8 and 0.8 nmol/L respectively). Glutamate decarboxylase (GAD) antibody was positive. HLA DQ beta chain substitution of aspartate molecule was at position 57 (susceptic gene). LADA could be diagnosed if a patient has the first point and any point of the second to the fourth point. Patients with LADA should take diet, exercises, especially insulin as early as possible in order to control fasting and post prandial plasma glucose, and prevent from further destroy of residue islet B cells and reduce diabetic complications of eye, kidney and nerve.更多还原