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目的探讨谷氨酸脱羧酶抗体(GAD-Ab)、蛋白酪氨酸磷酸酶抗体(IA-2Ab)和SOX13抗体(SOX13-Ab)在不同发病年龄的酮症倾向糖尿病(KPD)患者中的分布规律及其与临床特征的相关性。方法250例KPD患者分为不同的发病年龄组(≤12岁,13～18岁,19～44岁,≥45岁),比较各组患者上述三种抗体的分布规律,探讨胰岛自身抗体异质性对KPD患者临床表型的影响。结果 (1)随发病年龄增加,GAD-Ab、IA-2Ab阳性率呈递减趋势,SOX13-Ab阳性率呈递增趋势;其中,儿童(≤12岁)及青少年(13～18岁)发病的KPD患者中GAD-Ab阳性率显著高于IA-2Ab及SO13-Ab阳性率,儿童发病组中GAD-Ab/IA-2Ab双阳性率显著高于成年发病(≥19岁)组(P均<0.05)。(2)儿童及青少年发病者表现为低BMI、低代谢综合征(MS)及低大血管/微血管并发症发生率(病程≤5年);而中老年(≥45岁)发病者具有胰岛功能好、MS发生率高等特点(P均<0.05)。(3)GAD-Ab、IA-2Ab及SOX13-Ab任一阳性的KPD患者中,IA-2Ab/SOX13-Ab双阳性组胰岛功能显著高于其他抗体状态组。结论 KPD患者中GAD-Ab、IA-2Ab及SOX13-Ab的分布具有与发病年龄相关的异质性,这可部分解释不同发病年龄KPD患者临床特征的差异性。
Objective To investigate the distribution of glutamic acid decarboxylase antibody (GAD-Ab), protein tyrosine phosphatase antibody (IA-2Ab) and SOX13 antibody (SOX13-Ab) in patients with ketosis-prone diabetes mellitus (KPD) Regularity and its correlation with clinical features. Methods 250 patients with KPD were divided into different age groups (≤12 years old, 13-18 years old, 19-44 years old, ≥45 years old). The distribution of above three antibodies in each group were compared to explore the islet autoantibody heterogeneity Effect of sex on clinical phenotype in KPD patients. Results (1) The positive rates of GAD-Ab and IA-2Ab showed a decreasing trend with the increasing age of onset, and the positive rates of SOX13-Ab showed an increasing trend. Among them, the incidence of KPD in children (≤12 years) and adolescents (13-18 years) The positive rate of GAD-Ab in patients was significantly higher than that of IA-2Ab and SO13-Ab. The positive rates of GAD-Ab / IA-2Ab in children were significantly higher than those in adults (≥19 years old) ). (2) Children and adolescents with low BMI, low metabolic syndrome (MS) and low blood vessel / microvascular complications (duration ≤ 5 years); while middle-aged and older (≥45 years) patients with islet function Good, high incidence of MS (P <0.05). (3) Among the positive KPD patients with GAD-Ab, IA-2Ab and SOX13-Ab, the islet function of IA-2Ab / SOX13-Ab double positive group was significantly higher than that of other antibody group. Conclusions The distribution of GAD-Ab, IA-2Ab and SOX13-Ab in patients with KPD has age-related heterogeneity, which may partly explain the differences of clinical features in patients with KPD at different ages of onset.