成人隐匿性自身免疫性糖尿病（LADA）、2 型糖尿病和经典 1 型糖尿病患者的临床前颈动脉粥样硬化。
Preclinical carotid atherosclerosis in patients with latent autoimmune diabetes in adults (LADA), type 2 diabetes and classical type 1 diabetes.
机构信息
Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain.
Nursing School, Universitat de Lleida, Lleida, Spain.
出版信息
Cardiovasc Diabetol. 2017 Jul 28;16(1):94. doi: 10.1186/s12933-017-0576-9.
BACKGROUND
LADA is probably the most prevalent form of autoimmune diabetes. Nevertheless, there are few data about cardiovascular disease in this group of patients. The aim of this study was to investigate the frequency of carotid atherosclerotic plaques in patients with LADA as compared with patients with classic type 1 diabetes and type 2 diabetes.
METHODS
Patients with LADA were matched for age and gender in different proportions to patients with type 2 diabetes, and classic type 1 diabetes. None of the patients had clinical cardiovascular disease. All subjects underwent B-mode carotid ultrasound to detect atheroma plaques. Demographics were obtained from all subjects.
RESULTS
We included 71 patients with LADA, 191 patients with type 2 diabetes and 116 patients with type 1 diabetes. Carotid atherosclerosis was more frequent in patients with LADA compared with type 2 diabetes (73.2% vs. 56.9%, P = 0.0018) and classic type 1 diabetes (57.1%, P = 0.026); these changes occurred despite healthier macrovascular risk profiles in the former. Age (P < 0.001), smoking (P = 0.003) and hypertension (P = 0.019) were independently associated with carotid atherosclerosis. Multiple plaques were also more frequent in patients with LADA as compared with classic type 1 diabetes and type 2 diabetes (45.1% and 33.6% vs. 27.2%, respectively, P = 0.022). The frequency of carotid plaques increased with increasing diabetes duration in LADA patients compared with type 2 diabetes (85.7% vs. 58.8%, inverse OR 5.72 [1.5-21.8]; P = 0.009).
CONCLUSIONS
LADA patients do not present with less carotid atherosclerosis than patients with type 1 and type 2 diabetes. Their macrovascular risk occurs despite a healthier macrovascular risk profile than those patients with type 2 diabetes.
背景
LADA 可能是最常见的自身免疫性糖尿病形式。然而，关于这组患者的心血管疾病的数据很少。本研究的目的是比较 LADA 患者与 1 型经典糖尿病和 2 型糖尿病患者颈动脉粥样硬化斑块的发生频率。
方法
将 LADA 患者按年龄和性别与 2 型糖尿病和 1 型经典糖尿病患者以不同比例匹配。所有患者均无临床心血管疾病。所有受试者均接受 B 型颈动脉超声检查以检测动脉粥样硬化斑块。从所有受试者中获取人口统计学数据。
结果
我们纳入了 71 例 LADA 患者、191 例 2 型糖尿病患者和 116 例 1 型糖尿病患者。与 2 型糖尿病患者（73.2% vs. 56.9%，P=0.0018）和 1 型经典糖尿病患者（57.1%，P=0.026）相比，LADA 患者颈动脉粥样硬化更为常见；尽管前者的大血管风险状况更健康，但仍存在这种变化。年龄（P<0.001）、吸烟（P=0.003）和高血压（P=0.019）与颈动脉粥样硬化独立相关。与 1 型经典糖尿病和 2 型糖尿病患者相比，LADA 患者的多发性斑块更为常见（45.1%和 33.6% vs. 27.2%，分别，P=0.022）。与 2 型糖尿病患者相比，LADA 患者的颈动脉斑块发生率随糖尿病病程的增加而增加（85.7% vs. 58.8%，逆 OR 5.72[1.5-21.8]；P=0.009）。
结论
LADA 患者的颈动脉粥样硬化并不比 1 型和 2 型糖尿病患者少。尽管他们的大血管风险状况比 2 型糖尿病患者更健康，但仍会出现这种情况。
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