2型糖尿病患者产生胰岛素抗体的危险因素分析

Analysis of Risk Factors for Insulin Antibodies in Type 2 Diabetes Patients

摘要: 目的：分析2型糖尿病(Type 2 Diabetes mellitus, T2DM)患者产生胰岛素抗体(Insulin Antibody, IA)的危险因素。方法：统计2017/1/1至2018/7/1于青岛大学附属医院内分泌科住院收治的T2DM患者742例，所有患者均使用外源性胰岛素并测定IA且有完整资料，根据IA是否阳性，分为IA阳性组220例和IA阴性组522例。两组患者均进行常规血液生化检验，并收集相关病例资料，分析T2DM患者IA的危险因素。结果：1) 比较阳性组与阴性组一般及临床资料发现其中年龄、病程、入院前胰岛素使用剂量、胆固醇、低密度脂蛋白、高密度脂蛋白、尿酸、游离甲状腺素在两组中存在统计学差异(P < 0.05)；2) Logistic回归分析发现病程、胆固醇、高密度脂蛋白、尿酸是使用胰岛素治疗的T2DM患者发生IA阳性的独立危险因素(P < 0.05)；3) 将危险因素中的病程按四分位数赋值分组，不同病程组患者其IA阳性率有统计学差异(P < 0.01)；随着病程增加，IA水平升高，空腹C肽水平及胰岛β细胞功能指数下降。结论：使用胰岛素治疗的T2DM患者，随着患糖尿病时间越长、胆固醇水平越高、尿酸水平越高以及高密度脂蛋白水平越低，发生IA阳性的风险越高。

Abstract: Objective: To analyze the risk factors of insulin antibody (IA) in patients with Type 2 Diabetes mellitus (T2DM). Methods: A total of 742 T2DM patients were admitted to the department of endocrinology, affiliated hospital of Qingdao university from 2017/1/1 to 2018/7/1. All the patients were treated with exogenous insulin and IA was measured with complete data. According to whether IA was positive or not, there were 220 patients in the IA positive group and 522 patients in the IA negative group. Routine blood biochemical tests were performed in both groups, and relevant case data were collected to analyze the risk factors of IA in patients with T2DM. Results: 1) Comparing the general and clinical data of the positive group and the negative group, it was found that there were statistical differences in age, course of disease, dose of insulin used before admission, cholesterol, LDL, HDL, uric acid and free thyroxine between the two groups (P < 0.05); 2) Logistic regression analysis found that course of disease, cholesterol, high-density lipoprotein and uric acid were independent risk factors for IA positive in T2DM patients treated with insulin (P < 0.05); 3) The disease duration of risk factors was divided into four groups according to quartile assignment, and the IA positive rate of patients in different disease duration groups was statistically different (P < 0.01); as the course of disease increased, IA level increased, fasting c-peptide level and islet insulin function index decreased. Conclusion: Patients with T2DM treated with insulin had a higher risk of being IA positive with longer diabetes, higher cholesterol levels, higher uric acid levels, and lower HDL levels.