尿 C 肽/肌酐比值鉴别儿童 1 型与 2 型糖尿病。
Urinary C-peptide creatinine ratio to differentiate type 2 diabetes mellitus from type 1 in pediatric patients.
机构信息
Pediatric Department, Faculty of Medicine, Tanta University Hospital, El motasem street No 6, Tanta, Egypt.
Clinical Pathology Department, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt.
出版信息
Eur J Pediatr. 2020 Jul;179(7):1115-1120. doi: 10.1007/s00431-020-03606-7. Epub 2020 Feb 13.
Type 2 diabetes mellitus (T2DM) is frequently misdiagnosed in children and treated as type 1 DM (T1DM) with insulin. Urinary C-peptide to creatinine ratio (UCPCR) can be used to measure ß cell function and endogenous insulin. We aimed to assess the value of UCPCR to differentiate T2DM from T1DM in pediatric patients. We assessed UCPCR from urine sample taken 2 h after lunch in 50 children with T1DM and 30 children with T2DM (duration of the disease ≥ 2 years and without renal impairment). Fasting and postprandial C-peptide levels were also evaluated in all included children. Receiver operating characteristic (ROC) curve was performed to assess the optimal UCPCR cutoff level to differentiate T2DM from T1DM in children. UCPCR was significantly lower in children with T1DM compared with those with T2DM (P < 0.001). There was a significant positive correlation between UCPCR and fasting C-peptide, postprandial C-peptide, and age of onset. There was a significant negative correlation between the UCPCR and both HbA1c and duration of DM in T1DM. Fasting C-peptide had a sensitivity of 63%, a specificity of 84% at a cutoff point ≥ 1.3 ng/ml to differentiate T2DM from T1DM. Postprandial C-peptide had a sensitivity of 87%, a specificity of 86% at a cutoff point ≥ 3.2 ng/ml to differentiate T2DM from T1DM. Finally, UCPCR had a sensitivity of 97%, a specificity of 88% at a cutoff point ≥ 0.28 nmol/nmol to differentiate T2DM from T1DM in pediatric patients.Conclusion: UCPCR is an easy noninvasive reliable marker to differentiate T2DM from T1DM in pediatric patients.What is Known:• Type 2 DM (T2DM) is frequently misdiagnosed in children and treated as type 1 DM (T1DM) with insulin.• Urinary C-peptide to creatinine ratio (UCPCR) can be used to measure ß cell function and endogenous insulin.What is New:• We revealed that UCPCR had a sensitivity of 97%, a specificity of 88% at a cutoff point ≥ 0.28 nmol/nmol to differentiate T2DM from T1DM.• UCPCR is an easy noninvasive dependable marker to diagnose T2DM from T1DM in pediatric patients.
2 型糖尿病（T2DM）在儿童中常被误诊为 1 型糖尿病（T1DM）并接受胰岛素治疗。尿 C 肽与肌酐比值（UCPCR）可用于测量β细胞功能和内源性胰岛素。我们旨在评估 UCPCR 在儿童患者中区分 T2DM 和 T1DM 的价值。我们评估了 50 例 T1DM 患儿和 30 例 T2DM 患儿（病程≥2 年且无肾功能损害）午餐后 2 小时尿液样本中的 UCPCR。所有纳入的儿童均评估了空腹和餐后 C 肽水平。进行受试者工作特征（ROC）曲线分析以评估 UCPCR 区分儿童 T2DM 和 T1DM 的最佳截断值。与 T2DM 患儿相比，T1DM 患儿的 UCPCR 明显更低（P<0.001）。UCPCR 与空腹 C 肽、餐后 C 肽和发病年龄呈显著正相关。T1DM 患儿的 UCPCR 与 HbA1c 和糖尿病病程呈显著负相关。空腹 C 肽的截断值≥1.3ng/ml 时，对区分 T2DM 和 T1DM 的灵敏度为 63%，特异性为 84%。餐后 C 肽的截断值≥3.2ng/ml 时，对区分 T2DM 和 T1DM 的灵敏度为 87%，特异性为 86%。最后，UCPCR 的截断值≥0.28nmol/nmol 时，对区分儿童 T2DM 和 T1DM 的灵敏度为 97%，特异性为 88%。结论：UCPCR 是一种简单、非侵入性、可靠的标志物，可用于区分儿童 T2DM 和 T1DM。已知：• T2DM（T2DM）在儿童中常被误诊为 1 型糖尿病（T1DM）并接受胰岛素治疗。• 尿 C 肽与肌酐比值（UCPCR）可用于测量β细胞功能和内源性胰岛素。新发现：• 我们发现，UCPCR 的截断值≥0.28nmol/nmol 时，对区分 T2DM 和 T1DM 的灵敏度为 97%，特异性为 88%。• UCPCR 是一种简单、非侵入性、可靠的标志物，可用于诊断儿科 T2DM 和 T1DM。
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