【摘要】 目的　探讨成人隐匿性自身免疫糖尿病 (LADA)患者胰岛功能变化的特点及其影响因素。方法　 2型糖尿病 (DM )中谷氨酸脱羧酶抗体 (GAD Ab)阳性的LADA患者 16例和GAD Ab阴性的 2型DM患者 2 4例 ,分别于第 0、6、12、3 0、3 6、42和 48个月进行随访 ,测定空腹C肽 (FCP)和 10 0 g馒头餐后 2hC肽 ( 2hCP)及糖代谢指标。采用放免法测定GAD Ab和C肽。结果　LADA组的FCP于第 3 0、3 6、42、48个月明显下降 ,而C肽较入组时下降 5 0 %以上者所占百分比则均于第 12个月时明显增加 (P <0 .0 5 ) ,2型DM组的胰岛功能在随访期间则无显著性变化。LADA入组时的GAD Ab滴度与随访结束时FCP下降的差值 (ΔFCP)呈正相关 (rs=0 .5 0 ,P =0 .0 5 ) ,而体重指数 (rs=-0 .64 ,P <0 .0 1)、发病年龄 (rs=-0 .5 7,P <0 .0 5 )与ΔFCP呈负相关 ,空腹血糖 (rs=0 .64 ,P <0 .0 1)与ΔFCP呈正相关。经多元逐步回归分析 ,GAD Ab、性别、发病年龄和病程为LADA患者胰岛 β细胞功能的影响因子。 结论　LADA患者胰岛 β细胞功能较 2型DM下降更快 ,GAD Ab滴度是预测胰岛功能减退速度的重要因素 ,而且发病年龄轻、男性和病程较长对LADA患者的胰岛 β细胞功能的减退亦有一定预测作用。更多还原

【Abstract】 Objective To study the characteristics of β cell function change and to explore the predictive value of glutamic acid decarboxylase (GAD)-Ab and other factors for β cell function in the patients with latent autoimmune diabetes of adults (LADA). Methods Sixteen LADA patients (positive GAD-Ab) and 24 type 2 diabetic patients (negative GAD-Ab) were followed-up at 0, 6th, 12th, 30th, 36th, 42th and 48th months respectively. Their fasting and postprandial 2h C-peptide and glycemic control were measured. GAD-Ab was determined by radioimmunoprecipitation assay and C-peptide by RIA. Results Decreased fasting C peptide (FCP) levels (Month 30, 36, 42, 48 compared with Month 0, P<0.05-<0.01) were found in LADA patients, while the percentage of patients whose FCP decreased beyond 50% compared with Month 0 was greatly increased at 12th month (P<0.05). No changes of the above parameters in type 2 DM patients were found. The index of GAD-Ab at Month 0 was positively correlated with the decrease of FCP (ΔFCP) in LADA patients during the follow-up (r s=0.50,P=0.05), other factors such as BMI (r s=-0.64,P<0.05), age at onset (r s=-0.57,P<0.05) and fasting blood glucose (r s=0.64,P<0.01) were correlated with ΔFCP. Using multiple stepwise regression analysis, GAD-Ab, sex, age at onset and duration were found to be the important predictive factors for β cell function in LADA patients. Conclusion Islet β cell function decreases more quickly in LADA than in type 2 DM patients. The titer of GAD-Ab is an important factor to predict change of islet β cell function decline, whereas younger age at onset, longer duration and maleness may also be the predictors.更多还原