糖尿病自身抗体监测在GADA阳性LADA诊治中的意义
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摘要
目的探讨新诊断成人隐匿性自身免疫性糖尿病(LADA)患者胰岛素治疗6个月后胰岛功能和糖尿病自身抗体监测的意义。方法新诊断的LADA患者26例,均给予胰岛素控制血糖。治疗前后分别测量谷氨酸脱羧酶抗体(GADA)、胰岛细胞抗体(ICA)、糖化血红蛋白,并记录口服75 g葡萄糖粉试验空腹血糖、2 h血糖、空腹胰岛素、2 h胰岛素、空腹C肽、0.5 h C肽、2 h C肽,血脂;在治疗6个月后复查各个指标,比较治疗前后胰岛功能与糖尿病自身抗体的改变。结果①本组LADA患者初诊断时GADA均为阳性,ICA阳性为19例,胰岛素治疗6个月后,GADA滴度比治疗前下降(P<0.01),3例转为阴性,ICA阳性比治疗前减少8例(P<0.05)。②治疗后,空腹血糖、餐后2 h血糖、HbA1c下降明显(P均<0.01);空腹C肽、餐后0.5 h C肽、餐后2 h C肽均较治疗前升高(P分别<0.01,0.01,0.05);③血清总胆固醇和血清三酰甘油均较治疗前下降(P分别<0.01,0.05)。结论对新诊断LADA患者早期行胰岛素治疗能使胰岛β细胞功能恢复,减轻胰岛的免疫原性,从而缓解LADA的急性进展。
Objective To explore the monitoring value of islet function and diabetes auto-antibodies in the patients with newly-diagnosed latent autoimmune diabetes mellitus in adults(LADA) after insulin therapy for 6 months.Methods All 26 patients with newly-diagnosed LADA were given insulin to control blood glucose.Before and after treatment we measured the level of glutamate decarboxylase antibody(GADA),islet cell antibody(ICA),glycosylated hemoglobin(HbA1c),and recorded the fasting plasma glucose(FPG),2 hours blood glucose(2 hPG),fasting insulin(FINS),2 hours insulin(2hINS),fasting c-peptide(FCP),0.5 hours C peptide(0.5 h CP),2 hours C peptide(2 h CP) and blood fat before and after the oral glucose tolerance test.The change of islet function antibodies was evaluated before and after treatment.Results ①All the patients with GADA positive and 19 cases with ICA positive when they were diagnosed.After insulin therapy for 6 months,the level of GADA dropped significantly than before treatment(P<0.01),3 cases GADA turn negative,and ICA positive rate have reduced than(P<0.05) before treatment.②After treatment,the level of FPG,2 h PG,glycosylated hemoglobin A1c(HbA1c)reduced significantly in LADA(P<0.01).The level of FCP,0.5 h CP,2 h CP rose in LADA than before treatment(respectively,P<0.01,0.01,0.05).③The level of serum total cholesterol(TC) and serum three-acyl glycerin(TG) decreased compared with before treatment(P<0.01 or P<0.05).Conclusion Early insulin therapy in patients with newly-diagnosed LADA can recover pancreatic β cell function,reduce islet immunogenicity and lighten the acute progress of LADA.
Objective To explore the monitoring value of islet function and diabetes auto-antibodies in the patients with newly-diagnosed latent autoimmune diabetes mellitus in adults(LADA) after insulin therapy for 6 months.Methods All 26 patients with newly-diagnosed LADA were given insulin to control blood glucose.Before and after treatment we measured the level of glutamate decarboxylase antibody(GADA),islet cell antibody(ICA),glycosylated hemoglobin(HbA1c),and recorded the fasting plasma glucose(FPG),2 hours blood glucose(2 hPG),fasting insulin(FINS),2 hours insulin(2hINS),fasting c-peptide(FCP),0.5 hours C peptide(0.5 h CP),2 hours C peptide(2 h CP) and blood fat before and after the oral glucose tolerance test.The change of islet function antibodies was evaluated before and after treatment.Results ①All the patients with GADA positive and 19 cases with ICA positive when they were diagnosed.After insulin therapy for 6 months,the level of GADA dropped significantly than before treatment(P<0.01),3 cases GADA turn negative,and ICA positive rate have reduced than(P<0.05) before treatment.②After treatment,the level of FPG,2 h PG,glycosylated hemoglobin A1c(HbA1c)reduced significantly in LADA(P<0.01).The level of FCP,0.5 h CP,2 h CP rose in LADA than before treatment(respectively,P<0.01,0.01,0.05).③The level of serum total cholesterol(TC) and serum three-acyl glycerin(TG) decreased compared with before treatment(P<0.01 or P<0.05).Conclusion Early insulin therapy in patients with newly-diagnosed LADA can recover pancreatic β cell function,reduce islet immunogenicity and lighten the acute progress of LADA.
引文
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[9]祁贯成,童济,韩冬.胰岛素与口服降糖药治疗LADA的疗效及对胰岛功能影响的比较[J].徐州医学院学报,2004,24(1):59-60.
[10]Agardh CD,Lynch KF,Palmér M,et al.GAD65vaccination:5years of follow-up in a randomised dose-escalating study in adult-onset au-toimmune diabetes[J].Diabetologia,2009,52(7):1363-1368.
[11]杨琳,周智广,黄干.成人隐匿性自身免疫性糖尿病患者胰岛β细胞功能的6年前瞻性研究[J].中华糖尿病杂志,2004,12(5):335-339.
[2]王卫东,颜廷俊,石礼.胰岛素强化治疗对新诊断LADA患者胰岛素原的影响[J].中国医疗前沿,2009,4(14):17-30.
[3]孙胜花,宋钦华,刘海蔚,等.成人隐匿自身免疫性糖尿病患者临床特征分析[J].中国糖尿病杂志,2012,20(6):444-446.
[4]Fourlanos S,Dotta F,Greenbaum CJ,et al.Latentautoimmune diabetesin adults(LADA)should be less latent[J].Diabetologia,2005,48(11):2206-2212.
[5]Davies H,Brophy S,Fielding A,et al.Latent autoimmune diabetes in adults(LADA)in South Wales:incidence and characterization[J].Diabet Med,2008,25(11),1354-1357.
[6]Brooks-Worrell BM,Reichow JL,Goel A,et al.Identification of au-toantibody-negative autoimmune type2diabetic patients[J].Diabetes Care,2011,34(1):168-173.
[7]Iwasaki Y,Hamamoto Y,Kawasaki Y,et al.Japanese cases of acute onset diabetic ketosis without acidosis in the absence of glutamic acid decarboxylase autoantibody[J].Endocrine,2010,37(2):286-288.
[8]van Deutekom AW,Heine RJ.The islet autoantibody titres:their clini-cal relevance in latent autoimmune diabetes in adults(LADA)and the classification of diabetes mellitus[J].Diabetic Medicine,2008,25(2):117-125.
[9]祁贯成,童济,韩冬.胰岛素与口服降糖药治疗LADA的疗效及对胰岛功能影响的比较[J].徐州医学院学报,2004,24(1):59-60.
[10]Agardh CD,Lynch KF,Palmér M,et al.GAD65vaccination:5years of follow-up in a randomised dose-escalating study in adult-onset au-toimmune diabetes[J].Diabetologia,2009,52(7):1363-1368.
[11]杨琳,周智广,黄干.成人隐匿性自身免疫性糖尿病患者胰岛β细胞功能的6年前瞻性研究[J].中华糖尿病杂志,2004,12(5):335-339.