空腹C肽在1型糖尿病、2型糖尿病、青少年发病的成年型糖尿病（MODY）和成人隐匿性自身免疫性糖尿病（LADA）患者诊断鉴别中的应用
Utility of Fasting C-Peptide for the Diagnostic Differentiation of Patients with Type 1, Type 2 Diabetes, MODY, and LADA.
作者信息
Alemán-Contreras Ricardo, Gómez-Díaz Rita A, Noyola-García Maura E, Mondragón-González Rafael, Wacher Niels, Ferreira-Hermosillo Aldo
机构信息
Servicio de Medicina Interna, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico.
Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico.
出版信息
Life (Basel). 2024 Apr 25;14(5):550. doi: 10.3390/life14050550.
BACKGROUND
The prevalence of obesity has increased in patients with type 1 diabetes (T1D) and latent autoimmune diabetes of the adult (LADA), limiting the use of clinical features such as the body mass index for its differentiation with type 2 diabetes (T2D). Additionally, some patients with maturity-onset diabetes of the young (MODY) or LADA are misdiagnosed as having T2D. The evaluation of autoantibodies and genetic testing are not fully available. We aimed to evaluate the utility of a widely available and less expensive diagnostic tool such as C-peptide to differentiate between T1D, T2D, MODY, and LADA.
METHODS
Our study included 38 patients with T1D, 49 with T2D, 13 with MODY, and 61 with LADA. We recorded anthropometric measurements, biochemical profiles, and antidiabetic treatment and determined C-peptide, anti-GAD65, and anti-IA2 antibodies.
RESULTS
C-peptide concentration differed significantly among populations (T1D: 0.2 ng/mL; T2D: 2.4 ng/mL; MODY: 1.14 ng/mL; LADA: 1.87 ng/mL). Through a ROC curve, we observed that the C-peptide cut-off point of 0.95 ng/mL allows differentiation between T1D and T2D (sensitivity 82%, specificity 77%); 0.82 ng/mL between T1D and LADA (sensitivity 82%, specificity 77%); and 1.65 ng/mL between T2D and MODY (sensitivity 72%, specificity 72%).
CONCLUSIONS
C-peptide is useful for the diagnostic differentiation of patients with type 1, type 2 diabetes, MODY, and LADA.
背景
1型糖尿病（T1D）和成人隐匿性自身免疫性糖尿病（LADA）患者中肥胖的患病率有所上升，这限制了诸如体重指数等临床特征用于其与2型糖尿病（T2D）鉴别的作用。此外，一些青少年发病的成年型糖尿病（MODY）或LADA患者被误诊为T2D。自身抗体评估和基因检测尚未完全普及。我们旨在评估一种广泛可用且成本较低的诊断工具，如C肽，在鉴别T1D、T2D、MODY和LADA方面的效用。
方法
我们的研究纳入了38例T1D患者、49例T2D患者、13例MODY患者和61例LADA患者。我们记录了人体测量数据、生化指标和抗糖尿病治疗情况，并测定了C肽、抗谷氨酸脱羧酶（GAD65）抗体和抗胰岛细胞抗体（IA2）。
结果
不同人群的C肽浓度存在显著差异（T1D：0.2 ng/mL；T2D：2.4 ng/mL；MODY：1.14 ng/mL；LADA：1.87 ng/mL）。通过ROC曲线，我们观察到C肽截断值为0.95 ng/mL可区分T1D和T2D（敏感性82%，特异性77%）；截断值为0.82 ng/mL可区分T1D和LADA（敏感性82%，特异性77%）；截断值为1.65 ng/mL可区分T2D和MODY（敏感性72%，特异性72%）。
结论
C肽有助于对1型、2型糖尿病、MODY和LADA患者进行诊断鉴别。
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