2型糖尿病患者胰岛素自身抗体阳性的影响因素研究

李红娟; 时鹤; 崔岱

doi:10.7619/jcmp.20220889

2型糖尿病患者胰岛素自身抗体阳性的影响因素研究

李红娟¹,
时鹤²,
崔岱^1, ,

1.
南京医科大学第一附属医院内分泌科, 江苏南京, 210029
2.
南京医科大学第一附属医院核医学科, 江苏南京, 210029

基金项目:

江苏省“六大人才高峰”高层次人才项目 2016-WSN-023

详细信息

通讯作者:
崔岱, E-mail: cui_dai@163.com

中图分类号: R587.1;R446
计量
- 文章访问数: 168
- HTML全文浏览量: 82
- PDF下载量: 24
出版历程
- 收稿日期: 2022-03-20
- 网络出版日期: 2022-09-02

Influencing factors of positive insulin autoantibody in patients with type 2 diabetes mellitus

1.
Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029
2.
Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029

摘要

摘要:
目的
探讨2型糖尿病(T2DM)患者胰岛素自身抗体(IAA)阳性的临床特点及影响因素。
方法
检测163例T2DM患者的血清IAA水平, 并根据检测结果将患者分为IAA阳性组97例和IAA阴性组66例。比较2组患者一般资料、生化指标水平和胰岛素释放试验结果，分析T2DM患者IAA阳性的影响因素。
结果
IAA阳性组患者年龄大于IAA阴性组，病程长于IAA阴性组，游离三碘甲状腺原氨酸(FT₃)水平低于IAA阴性组，差异有统计学意义(P < 0.05); IAA阳性组使用预混胰岛素类似物者占比高于IAA阴性组，差异有统计学意义(P < 0.05)。年龄、糖尿病病程、FT₃水平、使用预混胰岛素类似物和胰岛素释放试验中0、180 min胰岛素水平均为T2DM患者IAA阳性的独立影响因素(P < 0.05)。
结论
年龄增长、病程延长和使用预混胰岛素类似物均可增加T2DM患者IAA阳性的发生风险，而FT₃水平降低和空腹胰岛素、餐后胰岛素水平明显升高时也应警惕IAA阳性的发生。
- 2型糖尿病 /
- 胰岛素自身抗体 /
- 胰岛素 /
- 游离三碘甲状腺原氨酸 /
- 血糖波动
Abstract:
Objective
To explore the clinical characteristics and influencing factors of positive insulin autoantibody (IAA) in patients with type 2 diabetes mellitus (T2DM).
Methods
The serum IAA was detected in 163 T2DM patients, and the patients were divided into IAA positive group(n=97) and IAA negative group(n=66). The general data, biochemical indexes and result of insulin release test were compared between the two groups, and the influencing factors of positive IAA were analyzed.
Results
The age of patients in the IAA positive group was older than that in the IAA negative group, the course of disease was longer than that in the IAA negative group, and the level of free triiodothyronine (FT₃) was lower than that in the IAA negative group(P < 0.05). The proportion of patients using premixed insulin analogue in the IAA positive group was higher than that in the IAA negative group (P < 0.05). Age, duration of diabetes, FT₃ level, use of premix insulin analogue and insulin levels at 0 and 180 min in insulin release test were independent risk factors of positive IAA in T2DM patients(P < 0.05).
Conclusion
Increasing age, prolongation of disease duration and use of premixed insulin analogues may increase the risk of positive IAA in T2DM patients. The decrease of FT₃ level and the significant increase of fasting insulin and postprandial insulin levels should also be noted for the occurrence ofpositive IAA.
- type 2 diabetes mellitus /
- insulin autoantibody /
- free triiodothyronine /
- blood glucose fluctuations /

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表 1 2组患者一般资料比较(x±s)[n(%)]

指标	分类	IAA阳性组(n=97)	IAA阴性组(n=66)
性别	男	58(59.79)	31(46.97)
	女	39(40.21)	35(53.03)
年龄/岁		60.76±12.67^*	56.02±15.13
病程/年		12.57±9.04^*	9.16±7.61
胰岛素类型	预混人胰岛素	23(23.71)	20(30.30)
	长效胰岛素类似物	27(27.84)	23(34.85)
	预混胰岛素类似物	47(48.45)^*	23(34.85)
体质量指数/(kg/m²)		25.88±3.63	25.38±3.77
收缩压/mmHg		136.14±17.17	135.17±21.00
舒张压/mmHg		75.65±11.87	77.89±12.68
高血压	有	28(28.87)	22(33.33)
	无	69(71.13)	44(66.67)
颈部动脉斑块	有	12(12.37)	0
	无	85(87.63)	66(100.00)
IAA: 胰岛素自身抗体。与IAA阴性组比较, *P < 0.05。

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表 2 2组血清检验指标水平比较(x±s)[M(Q₁, Q₃)]

指标	IAA阳性组(n=97)	IAA阴性组(n=66)
糖化血红蛋白/%	10.41±1.80^*	8.86±1.46
丙氨酸氨基转移酶/(U/L)	24.69±16.58	24.44±16.45
天门冬氨酸氨基转移酶/(U/L)	23.91±10.30	23.71±13.34
L-γ-谷氨酰转肽酶/(U/L)	24.50(17.85, 41.70)	25.85(17.63, 46.23)
碱性磷酸酶/(U/L)	88.72±35.91	84.08±28.19
乳酸脱氢酶/(U/L)	199.13±45.46	207.96±94.70
肌酸激酶/(U/L)	81.00(55.00, 113.00)	72.50(53.50, 101.75)
尿酸/(μmol/L)	306.87±85.34	292.82±85.09
尿素/(mmol/L)	5.95(4.89, 7.25)	5.63(4.59, 6.78)
肌酐/(μmol/L)	68.21±29.20	64.95±26.29
总胆固醇/(mmol/L)	4.67(3.78, 5.58)	4.74(4.04, 5.73)
甘油三酯/(mmol/L)	1.19(0.87, 1.78)^*	1.44(0.90, 2.36)
高密度脂蛋白胆固醇/(mmol/L)	1.04(0.93, 1.27)	1.07(0.90, 1.27)
低密度脂蛋白胆固醇/(mmol/L)	2.89±0.85	3.19±1.11
24 h尿蛋白/(mg/L)	134.00(96.50, 209.00)	158.50(114.75, 268.00)
促甲状腺激素/(mIU/L)	2.10(1.39, 2.99)	2.58(1.61, 3.21)
游离三碘甲状腺原氨酸/(pmol/L)	4.21±0.88^*	4.49±0.87
游离甲状腺素/(pmol/L)	17.42±6.19	17.72±3.77
0 min血糖/(pmol/L)	6.76±1.86	6.38±1.44
30 min血糖/(pmol/L)	9.66±2.80	9.59±2.07
60 min血糖/(pmol/L)	13.59±3.22	13.28±2.69
120 min血糖/(pmol/L)	16.65±4.13	16.31±3.25
180 min血糖/(pmol/L)	15.54±4.82	14.73±3.34
0 min胰岛素/(pmol/L)	39.40(23.75, 101.05)^*	26.70(15.90, 44.35)
30 min胰岛素/(pmol/L)	81.21(53.57, 197.10)^*	70.26(40.24, 136.15)
60 min胰岛素/(pmol/L)	153.10(86.96, 338.10)^*	119.00(70.47, 213.45)
120 min胰岛素/(pmol/L)	235.20(120.45, 441.50)^*	147.50(95.31, 269.48)
180 min胰岛素/(pmol/L)	184.40(111.70, 347.40)^*	116.50(81.09, 206.18)
0 min C肽/(pmol/L)	439.20(300.05, 643.40)	445.40(266.78, 629.50)
30 min C肽/(pmol/L)	595.40(477.40, 827.30)	664.65(515.70, 934.98)
60 min C肽/(pmol/L)	866.00(591.60, 1 244.00)	912.10(696.45, 1 374.00)
120 min C肽/(pmol/L)	1 420.00(916.90, 2 006.50)	1 455.50(1 059.00, 2 177.00)
180 min C肽/(pmol/L)	1 567.00(1 049.00, 2 038.50)	1 512.00(1 218.50, 2 051.25)
IAA: 胰岛素自身抗体。与IAA阴性组比较, *P < 0.05。

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表 3 T2DM患者IAA阳性影响因素的二元Logistic回归分析

变量	B	SE	Wald	df	P	OR
年龄	0.001	0.017	0.006	1	0.030	1.011
病程	0.037	0.028	1.847	1	0.012	1.163
预混胰岛素类似物	0.588	0.529	1.234	1	0.020	1.556
糖化血红蛋白	0.36	0.046	0.624	1	0.430	1.037
甘油三酯	0.116	0.099	1.385	1	0.239	1.123
游离三碘甲状腺原氨酸	-0.301	0.222	1.837	1	0.049	1.351
0 min胰岛素	0.005	0.004	1.997	1	0.048	1.095
30 min胰岛素	0.007	0.006	1.426	1	0.089	1.007
60 min胰岛素	0.003	0.004	0.549	1	0.050	1.097
120 min胰岛素	0.001	0.002	0.524	1	0.094	1.001
180 min胰岛素	0.003	0.002	2.408	1	0.012	1.097

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表 4 不同时点胰岛素水平中位数分组患者IAA阳性情况[n(%)]

胰岛素释放试验指标	中位数/(pmol/L)	中位数及以下组		中位数以上组
胰岛素释放试验指标	中位数/(pmol/L)	n	IAA阳性	n	IAA阳性
0 min胰岛素	33.69	82	38(46.34)	81	59(72.84)
180 min胰岛素	157.79	84	40(47.62)	79	57(72.15)
IAA: 胰岛素自身抗体。

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表 5 不同时点胰岛素水平四分位分组患者IAA阳性情况[n(%)]

四分位分组	0 min胰岛素			180 min胰岛素
四分位分组	范围/(pmol/L)	n	IAA阳性	范围/(pmol/L)	n	IAA阳性
Q₁组	< 19.39	41	19(46.34)^*	< 99.21	42	19(45.24)^*
Q₂组	19.39~33.69	41	19(46.34)^*	99.21~157.79	42	22(52.38)^*
Q₃组	>33.69~75.59	42	27(64.29)^*	>157.79~293.49	39	24(61.54)^*
Q₄组	>75.59	39	32(82.05)	>293.49	40	32(80.00)
IAA: 胰岛素自身抗体。与Q₄组比较, *P < 0.05。

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