可溶性CD8抗原、刺激后的C肽和胰岛细胞抗体是新诊断的无法分类糖尿病患者胰岛素需求的预测指标。

Soluble CD8 antigen, stimulated C-peptide and islet cell antibodies are predictors of insulin requirement in newly diagnosed patients with unclassifiable diabetes.

作者信息

Di Bonito P, De Bellis A, Capaldo B, Turco S, Corigliano G, Pace E, Bizzarro A

机构信息

II Department of Medicine, Civil Hospital of Pozzuoli, Naples, Italy.

出版信息

Acta Diabetol. 1996 Sep;33(3):220-4. doi: 10.1007/BF02048547.

DOI:10.1007/BF02048547

PMID:8904929

Abstract

To evaluate the predictive factors of insulin requirement in newly diagnosed patients with unclassifiable diabetes, 54 consecutive patients, aged less than 35 years, were prospectively followed for 3 years or more. At entry, haemoglobin HbA1c, basal and stimulated C-peptide concentrations, HLA phenotype, islet cell antibodies (ICA) status, and serum levels of soluble CD8 antigen (sCD8) were evaluated. After a median time of 9 (range 2-32) months, 31 patients (group 1) required insulin therapy, whereas 23 patients (group 2) remained non-insulin-requiring after 36 months. Group 1 patients were younger (P < 0.05) and had higher HbA1c and sCD8 serum levels (P < 0.0001), respectively), a higher frequency of ICA positivity and of HLA DR3 and/or DR4 phenotype (P < 0.005 and P < 0.0001, respectively), and lower C-peptide concentrations (P < 0.005 and P < 0.0001, basal and stimulated, respectively) than group 2. The sensitivity, specificity, positive and negative predictive value, and overall accuracy for the subsequent insulin requirement were: sCD8 serum levels (> 737 U/ml), 100%, 65%, 79%, 100% and 85%, respectively; stimulated C-peptide (< 0.60 nmol/l), 71%, 96%, 96%, 74% and 81%, respectively; and ICA positivity (> 20 JDFU), 45%, 91%, 87%, 55% and 65%, respectively. Thus, higher sCD8 serum levels, low stimulated C-peptide concentrations and ICA positivity are the most powerful predictors of subsequent recourse to insulin therapy in young, newly detected patients with unclassifiable diabetes.

摘要

为评估新诊断的分型不明糖尿病患者胰岛素需求的预测因素，对54例年龄小于35岁的连续患者进行了3年或更长时间的前瞻性随访。入组时，评估了血红蛋白糖化血红蛋白（HbA1c）、基础及刺激后C肽浓度、HLA表型、胰岛细胞抗体（ICA）状态以及可溶性CD8抗原（sCD8）的血清水平。经过9（范围2 - 32）个月的中位时间后，31例患者（第1组）需要胰岛素治疗，而23例患者（第2组）在36个月后仍无需胰岛素治疗。第1组患者更年轻（P < 0.05），HbA1c和sCD8血清水平更高（分别为P < 0.0001），ICA阳性以及HLA DR3和/或DR4表型的频率更高（分别为P < 0.005和P < 0.0001），且C肽浓度更低（基础和刺激后分别为P < 0.005和P < 0.0001），均低于第2组。对于后续胰岛素需求的敏感性、特异性、阳性和阴性预测值以及总体准确性分别为：sCD8血清水平（> 737 U/ml），分别为100%、65%、79%、100%和85%；刺激后C肽（< 0.60 nmol/l），分别为71%、96%、96%、74%和81%；以及ICA阳性（> 20 JDFU），分别为45%、91%、87%、55%和65%。因此，较高的sCD8血清水平、低刺激后C肽浓度和ICA阳性是年轻的新诊断分型不明糖尿病患者后续使用胰岛素治疗的最有力预测因素。