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目的:探讨中老年成年人迟发性自身免疫性糖尿病(LADA)的临床特征,找出临床筛查线索。方法:对住院的6 0例谷氨酸脱羧酶抗体(GADA)阳性中老年LADA患者和同期住院的1 2 0例GADA阴性的中老年2型糖尿病(T2DM )患者的临床资料进行比较。结果:中老年LADA患者较中老年T2DM患者有较短的从发病到需住院治疗的病程,较高的磺豚类降糖药继发失效(SUF)患者比例,较短的SUF时间,较低的体重指数(BMI) ,较低的代谢综合征(MS)患者比例,较低的空腹、餐后lh和2h血清C肽水平,P <0 . 0 5。而两组在有典型三多一少症状、糖尿病家族史、并发其他自身免疫疾病的患者比例及平均HbA1 c等均无统计学差异,P >0 . 0 5。结论:对住院的初诊为T2DM的中老年患者,容易SUF、低BMI、非MS、低C肽水平是筛查LADA的临床线索,确诊LADA则需测定胰岛自身抗体。
Objective: To investigate the clinical features of late-onset autoimmune diabetes (LADA) in middle-aged and elderly adults and find out the clinical screening clues. Methods: The clinical data of 60 hospitalized GADA positive elderly patients with LADA and 120 hospitalized GADA negative elderly patients with type 2 diabetes mellitus (T2DM) during the same period were compared. Results: Middle-aged and elderly patients with LADA had shorter duration of disease from onset to hospitalization than those with middle-aged and elderly patients with T2DM. The proportion of patients with secondary failure of spontaneous hypoglycemic agents (SUF), the shorter duration of SUF, was lower (BMI), lower proportion of patients with metabolic syndrome (MS), lower fasting, serum C-peptide levels at 1h and 2h after meal, P <0. There was no significant difference between the two groups in the proportion of patients with typical symptoms of more than one symptom, family history of diabetes and other autoimmune diseases, and mean HbA1c, P> 0.05. CONCLUSIONS: SUF, low BMI, non-MS, low C-peptide levels are the clinical clues for screening LADA in hospitalized newly diagnosed T2DM patients, and islet autoantibodies are required for the diagnosis of LADA.