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目的 探讨不同谷氨酸脱羧酶 (GAD65)抗体水平的成人隐匿性自身免疫糖尿病(LADA)患者的临床特点 ,了解LADA患者中是否存在两种不同的亚型。方法 对 750例临床初诊为2型糖尿病 (T2DM)患者及其志愿参加进一步研究的 2 95例患者用放免法进行GAD65抗体 (GADA)测定 ,绘制GADA指数的频数分布图 ,进行各组间临床特点的比较。结果 (1 )GADA在初诊 2型糖尿病中的阳性率为 9 7% ,高抗体水平者 (GADA指数≥ 0 5)占 2 8%。 (2 )LADA患者中抗体滴度较低(GADA指数 0 0 5～ <0 5)者在胰岛功能 (空腹C肽 50 0pmol/L比 50 4pmol/L ,P >0 0 5)、高血压比例(48 7%比 42 5 % ,P >0 0 5)及体重指数 (2 3 2kg/m2 比 2 2 3kg/m2 ,P >0 0 5)等方面与 2型糖尿病相似 ,即为LADA 2型 ;抗体滴度较高者 (GADA指数≥ 0 5)具有起病年龄小、胰岛功能差、更多使用胰岛素治疗 (P <0 0 1 )等特点 ,临床表现更类似经典的 1型糖尿病 ,即为LADA 1型。结论 LADA患者具有异质性 ,存在LADA 1和LADA 2两种亚型 ,LADA 1型的临床特点更类似于经典的 1型糖尿病
Objective To investigate the clinical features of patients with latent autoimmune diabetes (LADA) in patients with different levels of glutamic acid decarboxylase (GAD65) and to find out whether there are two different subtypes in LADA patients. Methods 750 cases of newly diagnosed type 2 diabetes mellitus (T2DM) and 2 95 patients who volunteered for further study were treated with GAD65 (GADA) by radioimmunoassay and the frequency distribution of GADA index was drawn. The clinical features of each group Comparison. Results (1) The positive rate of GADA in newly diagnosed type 2 diabetes mellitus was 97% and the level of high antibody (GADA index ≥ 05) accounted for 28%. (2) The antibody titer in patients with LADA was lower than that in patients with GADA (GADA index 0 0 5 ~ <5 5) (fasting C peptide 50 0 pmol / L vs 50 4 pmol / L, P 0 05) (48 7% vs 42 5%, P 0 05) and body mass index (223 kg / m 2 vs 2223 kg / m 2, P 0 05) ; Patients with higher antibody titer (GADA index ≥ 0 5) had the characteristics of younger onset age, poor islet function and more insulin treatment (P <0.01). The clinical manifestations were more similar to classic type 1 diabetes, ie, For LADA type 1. Conclusions The patients with LADA are heterogeneous, with two subtypes of LADA 1 and LADA 2. The clinical features of LADA type 1 are more similar to those of classic type 1 diabetes mellitus