Rattarasarn C, Aguilar Diosdado M, Soonthornpun S
Department of Medicine, Faculty of Medicine, Prince of Songkla University, Thailand.
Diabetes Res Clin Pract. 1997 Sep;37(3):193-7. doi: 10.1016/s0168-8227(97)00070-3.
The objective of this study was to determine the frequency of glutamic acid decarboxylase antibody (GAD-Ab) in Thai non-insulin-dependent diabetes (NIDDM) patients who had secondary sulfonylurea failure. Sera were collected from 40 NIDDM patients, who had history of secondary failure to treatment with sulfonylurea, for analysis of fasting c-peptide and GAD-Ab. Both c-peptide and GAD-Ab were measured using radioimmunoassay method. Of 40 patients, ten (25.0%) were positive for GAD-Ab with a mean level of 59.9 U/ml (median 58.5, range 3.4-127). Patients with (GAD-Ab (+) had a significantly lower fasting c-peptide levels than those with GAD-Ab(-) albeit shorter duration of diabetes (0.21 +/- 0.19 (S.D.) versus 0.52 +/- 0.33 nmol/l; P = 0.003). Duration of treatment with sulfonylurea in patients with GAD-Ab (+) was also shorter (4.6 +/- 3.5 versus 10.4 +/- 5.5 years; P = 0.001). Age at onset of diabetes did not differ between these two groups. Among 40% of patients who had insulin deficiency (fasting c-peptide level < 0.33 nmol/1), GAD-Ab was present in half and these GAD-Ab(+) patients had significantly shorter duration of sulfonylurea treatment (3.3 +/- 2.3 versus 10.0 +/- 7.9 years; P = 0.018). In conclusion, the frequency of GAD-Ab in Thai NIDDM patients with secondary sulfonylurea failure in this study was 25%. Almost all GAD-Ab(+) patients had insulin deficiency and most had been initially treated with sulfonylurea for a few years before depending on insulin. This group of patients represents a slowly progressive type I or latent autoimmune diabetes in adult diabetic population.
本研究的目的是确定泰国非胰岛素依赖型糖尿病（NIDDM）患者中继发磺脲类药物失效时谷氨酸脱羧酶抗体（GAD-Ab）的出现频率。收集了40例有磺脲类药物继发治疗失败史的NIDDM患者的血清，用于分析空腹C肽和GAD-Ab。C肽和GAD-Ab均采用放射免疫分析法测定。40例患者中，10例（25.0%）GAD-Ab呈阳性，平均水平为59.9 U/ml（中位数58.5，范围3.4-127）。GAD-Ab（+）患者的空腹C肽水平显著低于GAD-Ab（-）患者，尽管糖尿病病程较短（0.21±0.19（标准差）对0.52±0.33 nmol/l；P = 0.003）。GAD-Ab（+）患者的磺脲类药物治疗时间也较短（4.6±3.5对10.4±5.5年；P = 0.001）。这两组患者的糖尿病发病年龄无差异。在40%存在胰岛素缺乏（空腹C肽水平<0.33 nmol/1）的患者中，一半患者存在GAD-Ab，且这些GAD-Ab（+）患者的磺脲类药物治疗时间显著较短（3.3±2.3对10.0±7.9年；P = 0.018）。总之，本研究中泰国继发磺脲类药物失效的NIDDM患者中GAD-Ab的出现频率为25%。几乎所有GAD-Ab（+）患者都存在胰岛素缺乏，且大多数患者在依赖胰岛素治疗前最初接受了数年的磺脲类药物治疗。在成年糖尿病患者群体中，这组患者代表了缓慢进展的1型或潜伏性自身免疫性糖尿病。
