Mariana Fernández, Matías Fabregat, Gerardo Javiel, Adriana Mimbacas, Biodiversity and Genetic Department, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, CP 11600, Uruguay.
World J Diabetes. 2014 Oct 15;5(5):711-6. doi: 10.4239/wjd.v5.i5.711.
To investigate whether the presence of human leukocyte antigen (HLA) marker could add new information to discriminated atypical diabetic type 2 patients.
We analyzed 199 patients initially diagnosed as type 2 diabetes who are treated in special care diabetes clinics (3(rd) level). This population was classified in "atypical" (sample A) and "classic" (sample B) according to HLA typing. We consider "classic patient" when has absence of type 1 diabetes associated HLA alleles and no difficulties in their diagnosis and treatments. By the other hand, we considered "atypical patient" when show type 1 diabetes associated HLA alleles and difficulties in their diagnosis and treatments. The standard protocol Asociacion Latinoamericana de Diabetes 2006 was used for patients follow up. To analyze differences between both populations in paraclinical parameters we used unpaired t tests and contingence tables. Bivariate and multivariate analyses were carried out using the SPSS software program. In all studies we assume differences statistically significant, with a P-value < 0.05 corrected and 95%CI.
The typing HLA in the "atypical" populations show that 92.47% patients presented at list one type 1 diabetes associated HLA alleles (DQB1*0201-0302 and DR 3-4) and 7.53% had two of its. The results showed for categorical variables (family history, presence or absence of hypertension and/or dyslipidemia, reason for initial consultation) the only difference found was at dyslipidemia (OR = 0.45, 0.243 < OD < 0.822 (P < 0.001). In relation to continuous variables we found significant differences between atypical vs classic only in cholesterol (5.07 ± 1.1 vs 5.56 ± 1.5, P < 0.05), high density lipoproteins (1.23 ± 0.3 vs 1.33 ± 0.3, P < 0.05) and low density lipoproteins (2.86 ± 0.9 vs 3.38 ± 1.7, P < 0.01). None of the variables had discriminating power when logistic regression was done.
We propose an algorithm including HLA genotyping as a tool to discriminate atypical patients, complementing international treatment guidelines for complex patients.
研究人类白细胞抗原（HLA）标志物的存在是否可以为鉴别非典型 2 型糖尿病患者提供新信息。
我们分析了 199 名最初被诊断为 2 型糖尿病并在三级特殊护理糖尿病诊所接受治疗的患者。根据 HLA 分型，这些患者被分为“非典型”（样本 A）和“典型”（样本 B）。当患者缺乏 1 型糖尿病相关 HLA 等位基因且诊断和治疗无困难时，我们将其视为“典型患者”。另一方面，当患者表现出 1 型糖尿病相关 HLA 等位基因且诊断和治疗困难时，我们将其视为“非典型患者”。使用 2006 年拉丁美洲糖尿病协会的标准方案对患者进行随访。为了分析两组患者在临床相关参数方面的差异，我们使用了非配对 t 检验和列联表。使用 SPSS 软件程序进行了双变量和多变量分析。在所有研究中，我们假设差异具有统计学意义，P 值<0.05，置信区间为 95%。
“非典型”人群的 HLA 分型显示，92.47%的患者至少有一种 1 型糖尿病相关 HLA 等位基因（DQB1*0201-0302 和 DR3-4），7.53%的患者有两种。对于分类变量（家族史、高血压和/或血脂异常的存在或缺失、初始就诊的原因），结果显示唯一的差异是血脂异常（OR=0.45，0.243<OD<0.822（P<0.001）。对于连续变量，我们仅在胆固醇（5.07±1.1 与 5.56±1.5，P<0.05）、高密度脂蛋白（1.23±0.3 与 1.33±0.3，P<0.05）和低密度脂蛋白（2.86±0.9 与 3.38±1.7，P<0.01）方面发现了非典型组与典型组之间存在显著差异。当进行逻辑回归时，没有任何变量具有鉴别能力。
我们提出了一个包括 HLA 基因分型在内的算法，作为鉴别非典型患者的工具，补充了针对复杂患者的国际治疗指南。
