抗β细胞自身抗体预测临床诊断为2型糖尿病的儿科患者早期胰岛素需求。

Autoantibodies against beta cells to predict early insulin requirements in pediatric patients with clinically diagnosed type 2 diabetes.

作者信息

Molina Jorge M, Medina Patricia G, Gomez Rita A, Herrera Julia R, Martínez Nancy L, Hernández Brenda, García Yesenia

机构信息

Department of Endocrinology, Children's Hospital Federico Gomez, Mexico 06720, Mexico.

National Medical Center "Siglo XXI", UMAE Hosp Especialidades, Unidad Invest Med Epidemiol Clin, Mexican Social Security Institute, Mexico 06720, Mexico.

出版信息

World J Diabetes. 2024 Aug 15;15(8):1717-1725. doi: 10.4239/wjd.v15.i8.1717.

DOI:10.4239/wjd.v15.i8.1717

PMID:39192864

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11346091/

Abstract

BACKGROUND

Autoimmunity has emerged as a probable disease modifier in patients with clinically diagnosed type 2 diabetes mellitus (T2DM), that is, patients who have insulin resistance, obesity, and other cardiovascular risk factors, suggesting that the presence of glutamic acid decarboxylase (anti-GAD65), islet antigen 2 (anti-IA2), and zinc transporter 8 (anti-Zn8T) antibodies could have deleterious effects on beta cell function, causing failure and earlier requirement for insulin treatment.

AIM

To evaluate anti-GAD65, anti-IA2 and anti-Zn8T as predictors of early insulin requirement in adolescents with a clinical diagnosis of T2DM.

METHODS

This was a case-control study in patients with clinically diagnosed with T2DM (68 cases and 64 controls with and without early insulin dependence respectively), male and female, aged 12-18 years. Somatometry, blood pressure, glucose, insulin, C-peptide, glycated hemoglobin A1c, and lipid profiles were assessed. ELISA was used to measure anti-GAD65, anti-IA2, and anti-Zn8T antibodies. Descriptive statistics, Pearson's test, Student's test, and logistic regression was performed. < 0.05 was considered statistically significant.

RESULTS

There were 132 patients (53.8% female), with a mean age was 15.9 ± 1.3 years, and there was a disease evolution time of 4.49 ± 0.88 years. The presence of anti-GAD65, anti-IA2, and anti-Zn8T positivity was found in 29.5%, 18.2%, and 15.9%, respectively. Dividing the groups by early or no insulin dependence showed that the group with insulin had a higher frequency of antibody positivity: anti-GAD65 odds ratio (OR): 2.42 (1.112-5.303, 0.026); anti-IA2: OR: 1.55 (0.859-2.818, = 0.105); and anti-Zn8T: OR: 7.32 (2.039-26.279, = 0.002).

CONCLUSION

Anti-GAD65 positivity was high in our study. Anti-GAD65 and anti-Zn8T positivity showed a significantly depleted beta cell reserve phenotype, leading to an increased risk of early insulin dependence.

摘要

背景

自身免疫已成为临床诊断为2型糖尿病（T2DM）患者中一种可能的疾病修饰因素，即那些存在胰岛素抵抗、肥胖和其他心血管危险因素的患者，这表明谷氨酸脱羧酶（抗GAD65）、胰岛抗原2（抗IA2）和锌转运体8（抗Zn8T）抗体的存在可能对β细胞功能产生有害影响，导致β细胞功能衰竭以及更早需要胰岛素治疗。

目的

评估抗GAD65、抗IA2和抗Zn8T作为临床诊断为T2DM的青少年早期胰岛素需求预测指标的价值。

方法

这是一项病例对照研究，纳入临床诊断为T2DM的患者（68例病例组和64例对照组，分别为有和无早期胰岛素依赖的患者），年龄在12 - 18岁，男女均有。评估了体格测量、血压、血糖、胰岛素、C肽、糖化血红蛋白A1c和血脂谱。采用酶联免疫吸附测定法（ELISA）检测抗GAD65、抗IA2和抗Zn8T抗体。进行了描述性统计、Pearson检验、Student检验和逻辑回归分析。P < 0.05被认为具有统计学意义。

结果

共有132例患者（53.8%为女性），平均年龄为15.9 ± 1.3岁，疾病进展时间为4.49 ± 0.88年。抗GAD65、抗IA2和抗Zn8T阳性率分别为29.5%、18.2%和15.9%。根据是否早期胰岛素依赖对分组进行分析，结果显示胰岛素依赖组抗体阳性率更高：抗GAD65优势比（OR）：2.42（1.112 - 5.303，P = 0.026）；抗IA2：OR：1.55（0.859 - 2.818，P = 0.105）；抗Zn8T：OR：7.32（2.039 - 26.279，P = 0.002）。