成年隐匿性自身免疫性糖尿病临床特点分析

Clinical features of latent autoimmune diabetes in adults: a retrospective report of 78 cases

摘要:

目的 了解不同病程时成年隐匿性自身免疫性糖尿病（LADA）及成年1型糖尿病（T1DM）患者的临床特点，比较LADA及成年T1DM患者在治疗方面的区别，为临床上LADA患者合理诊治提供理论基础。方法 回顾性地分析2007年1月至2014年12月在北京协和医院收治的LADA患者的临床资料，探讨病程进展，LADA患者与成年起病的T1DM患者的临床特征及并发症的情况；比较两者在胰岛素剂量及口服药物使用情况，了解LADA患者的治疗特点。结果 本研究共包括78例LADA住院患者与110例成年T1DM患者。与成年T1DM患者相比，LADA患者的起病年龄较大（P＜0.01）、体质量指数（BMI）较大（P＜0.05）、发生糖尿病酮症酸中毒的概率更低（P＜0.01）、糖化血红蛋白（HbA1c）较低（P＜0.05）、谷氨酸脱羧酶抗体（GADA）和胰岛素抗体（IAA）抗体阳性率更高（P＜0. 05）。在病程≤5年时，与成年T1DM组患者相比，LADA组患者空腹C肽水平较高，HbA1c较低，并且使用胰岛素剂量较低。随着病程的进展，两组患者胰岛功能都明显下降，并且两组间糖尿病并发症发生率差异无统计学意义（P＞0.05）。LADA患者较成年T1DM患者多合并使用口服药，以α糖苷酶抑制剂为主。结论 LADA患者较成年T1DM起病年龄要大，体型偏胖，糖尿病酮症酸中毒倾向不明显，GADA及IAA抗体阳性率较高。尽管LADA在起病时临床特征倾向于2型糖尿病，胰岛功能呈缓慢下降，但随着病程延长，最终与T1DM临床特征一致，胰岛功能趋近于无。在治疗LADA患者时，可联合服用降糖药物，维持血糖的稳定性。

Abstract:

Objective To analyze the clinical features of latent autoimmune diabetes in adults (LADA) and adult- onset type 1 diabetes mellitus (T1DM) of different durations, and investigate their differences in order to found theoretic basis for rational diagnosis and treatment of LADA. Methods Clinical data of all hospitalized patients with LADA and those with adult- onset T1DM admitted in Peking Union Medical College Hospital from Jan. 2007 to Dec. 2014 were collected and analyzed retrospectively. The clinical characteristics and complications of the two diseases were explored with the duration of disease. Insulin dosages and oral administration of drugs were compared between the 2 groups of patients for the therapeutic features of LADA. Results There were 78 patients with LADA and 110 patients with adult- onset T1DM recruited in this study. Compared with the patients with adult- onset T1DM, those of LADA had older age of onset (P<0.01), larger body mass (P<0.05), lower incidence of diabetic ketoacidosis (P<0.01), decreased serum level of HbA1c (P<0.05), and higher positive rates of glutamic acid decarboxylase antibodies (GADA) and insulin antibodies (IAA) (P<0.05). For the patients with the disease duration of ≤5 years, LADA patients had higher level of fasting C peptide but lower level of HbA1c, and lower dosage of insulin when compared with adult- onset T1DM patients. The islet function was decreased obviously with the duration of disease in the both groups. But no significant difference was seen in the incidences of complications between the groups. There were more LADA patients treated in the combination of insulin and oral hypoglycemic drugs (mainly α- glucosidase inhibitors). Conclusion Compared with adult- onset T1DM patients, the LADA patients are older at the age of onset, heavier of body mass, of unobvious tendency of ketoacidosis, and higher positive rates of GADA and IAA. Though the clinical features of LADA are similar to those of T2DM at the onset (with gradually decreased islet β cell function), the features become consistent with those of T1DM with its progression (with almost loss of the function). In the treatment of LADA, oral hypoglycemic drugs should be combined to keep blood glucose stable.