Zhang Chi, Zhou Zhi-Guang, Lin Jian, Huang Gan, Wang Jian-Ping, Zhang Dong-Mei, Zhou Min, Yang Xiao-Lin
Diabetes Center, Institute of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Zhonghua Yi Xue Za Zhi. 2008 Mar 25;88(12):797-801.
To investigate the feasibility of ABC typing to redefine the subtypes of acute-onset type 1 diabetes mellitus (DM).
Radioligand assay was used to detect glutamic acid decarboxylase-antibody (GAD-Ab) and tyrosine phosphatase autoantibody (IA-2A) in 308 patients with acute-onset type 1 DM. The patients were thus divided into 2 groups: pancreatic islet auto-antibody (demonstrated as A) positive group--positive in GAD-Ab or IA-2A--and pancreatic islet auto-antibody negative group. The clinical features and frequencies of HLA-DQ genotypes of these groups were compared. Within 24 hours after the correction of diabetic ketosis or diabetic ketoacidosis and after fasting for at least 8 h fasting and postprandial venous blood samples were collected to detect the fasting C peptide (FCP, demonstrated as B) reflecting the beta cell function, and postprandial C peptide (PCP). The patients were followed up for 2 years to know the insulin dosage (< 20 U/d or > or = 20 U/d). Receiver operating characteristic curve (ROC) was drawn to judge the values of fasting C peptide, body mass index (BMI, demonstrated as C) reflecting the central obesity, and HLA-DQ genotype in further typing among the A + and A - patients and the optimal cutoff points thereof.
Compared with the A - group, the metabolic disorders at the onset were more severe, the insulin dosage at the 2-year follow-up was higher, and the percentage of susceptible HLA-DQ genotype was higher in the A + group (P < 0.05 or < 0.01). The level of FCP (B) could be used to further subtyping in both A + and A - groups, with the optimal cutoff point of 150 pmol/L in the A + group and with the optimal cutoff point of 250 pmol/L in the A - group. BMI could be used for further classification in only A - group with the optimal cutoff point of 24 kg/m2. HLA-DQ genotypes were of little value in further classification both in A + and A - groups.
ABC typing may be used as a new way to redefine the subtypes in acute-onset type 1 DM for prognosis.
探讨ABC分型法重新定义急性起病1型糖尿病（DM）亚型的可行性。
采用放射配体分析法检测308例急性起病1型糖尿病患者的谷氨酸脱羧酶抗体（GAD-Ab）和酪氨酸磷酸酶自身抗体（IA-2A）。将患者分为2组：胰岛自身抗体（以A表示）阳性组——GAD-Ab或IA-2A阳性——和胰岛自身抗体阴性组。比较两组的临床特征和HLA-DQ基因型频率。在糖尿病酮症或糖尿病酮症酸中毒纠正后24小时内，且至少禁食8小时后，采集空腹及餐后静脉血样本，检测反映β细胞功能的空腹C肽（FCP，以B表示）和餐后C肽（PCP）。对患者进行2年随访，了解胰岛素用量（<20 U/d或≥20 U/d）。绘制受试者工作特征曲线（ROC），判断空腹C肽、反映中心性肥胖的体重指数（BMI，以C表示）和HLA-DQ基因型在A+和A-患者进一步分型中的价值及其最佳截断点。
与A-组相比，A+组起病时代谢紊乱更严重，2年随访时胰岛素用量更高，易感HLA-DQ基因型百分比更高（P<0.05或<0.01）。FCP（B）水平可用于A+和A-组的进一步分型，A+组的最佳截断点为150 pmol/L，A-组的最佳截断点为250 pmol/L。BMI仅可用于A-组的进一步分类，最佳截断点为24 kg/m2。HLA-DQ基因型在A+和A-组的进一步分类中价值不大。
ABC分型法可作为重新定义急性起病1型糖尿病亚型以判断预后的新方法。
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