LADA和2型糖尿病临床和慢性并发症特点及胰腺体积的比较研究
发布时间：2019-07-06 15:20
【摘要】：成人迟发型自身免疫性糖尿病(latent autoimmune diabetes in adults,LADA)是成人自身免疫性糖尿病的一个亚型,起病初期其临床特点与2型糖尿病极其相似,很难与2型糖尿病鉴别。但随着病程进展,胰岛β细胞功能衰竭速度较2型糖尿病快,表现与2型糖尿病不同的临床特点。同时,LADA临床特点又不同于青少年起病的经典1型糖尿病。目前,国内对LADA慢性并发症的患病特点及其危险因素的研究报道较少。尚缺乏对LADA慢性并发症发生的有效预测模型。尽管目前关于LADA病生理机制研究较多,但关于LADA胰腺形态的变化特点及其与临床特点之间的关系,特别是胰腺体积对LADA胰岛β细胞功能的评估作用目前尚缺乏相关研究报道。第一部分LADA与2型糖尿病临床特点与慢性并发症关系的研究目的比较LADA和2型糖尿病两组患者临床特点、慢性并发症异同点。并进一步分析两组患者慢性并发症的危险因素,构建慢性并发症发生的预测模型。研究对象和方法本研究为横断面研究,收集了近10年来我科住院的成人起病的(糖尿病诊断年龄:30~75岁)并进行了胰岛相关抗体检测的表型为2型糖尿病的6,975例住院患者资料。我们根据相同年龄、同性别、相同病程将LADA患者与2型糖尿病患者进行1:2匹配,并比较LADA和2型糖尿病患者临床特点和慢性并发症特点的异同点。并进一步采用临床指标,包括包括性别、年龄、糖尿病病程、血糖控制水平(Hb A1c≥9.0%)、高血压病、高甘油三脂血症、低高密度脂蛋白胆固醇血脂以及BMI为自变量,各慢性并发症为因变量,拟合logistic回归方程,构建糖尿病慢性并发症发生的预测模型,并绘制ROC曲线。结果384例(5.5%)患者被确诊为LADA。与2型糖尿病患者比较,LADA患者有较低的空腹C肽水平(1.77 ng/ml vs.1.18 ng/ml,P0.001),较低水平的收缩压、舒张压、BMI、TG和较高水平的HDL-C(P0.05)。此外,LADA患者代谢综合征及其组分的患病率显著低于2型糖尿病患者。当糖尿病病程5年时,LADA患者较2型糖尿病者有更低的糖尿病白蛋白尿(12.2%vs.21.8%,P=0.018)和糖尿病视网膜病变患病率(8.1%vs.15.9%,P=0.011);当病程≥5年时,两组患者上述慢性微血管并发症的患病率无显著差异。同时,观察到LADA患者中这两种微血管并发症患病率随病程延长呈快速增长趋势。LADA和2型糖尿病患者的大血管并发症(颈动脉斑块)患病率无显著差异。在糖尿病白蛋白尿和糖尿病视网膜病变预测模型中,LADA的ROC曲线下面积显著大于2型糖尿病(糖尿病白蛋白尿模型:0.75 vs.0.67,P=0.080;糖尿病视网膜病变模型:0.80 vs.0.69,P=0.018)。但在糖尿病大血管预测模型中,LADA和2型糖尿病ROC曲线下面积相似(P0.05)。结论与2型糖尿病患者比较,LADA患者代谢综合征及其相关组分的患病率均较低,但胰岛功能较差。当病程5年,LADA患者较2型糖尿病患者有较低的白蛋白尿和糖尿病视网膜病变的患病率,相似的大血管病变患病率;当病程≥5年,两组患者微血管和大血管并发症患病率均相似。此外,临床特点对LADA白蛋白尿和视网膜病变的预测效能优于2型糖尿病。第二部分BMI与LADA和2型糖尿病视网膜病变之间的关系目的探讨我国LADA和2型糖尿病患者中体质指数(body mass index,BMI)与糖尿病视网膜病变之间的关系及其可能机制。研究对象和方法共计有316例LADA患者和2,533例2型糖尿病患者纳入研究。所有的患者均进行了双侧眼底免散瞳摄片并由专业眼科医师读片。糖尿病视网膜病变根据其严重程度分为以下3个等级:无眼底病变(non-DR),轻中度视网膜病变(DRI~II期),和影响视力的视网膜病变(DR III~IV期);任何程度糖尿病视网膜病变包括DR I~IV期。体质指数(kg/m2)分为3类:正常体重(18.5≤BMI25),超重(25≤BMI30),和肥胖(BMI≥30)。BMI18.5 kg/m2患者未纳入本研究。结果共计有69例LADA患者(21.8%)和701例(27.7%)2型糖尿病患者伴发糖尿病视网膜病变。LADA患者中,与无视网膜病变的患者比较,合并糖尿病视网膜病变者其BMI无显著性差异(23.0 kg/m2 vs.22.8 kg/m2,P=0.211),但腰围水平略高(85 cm vs.84 cm,P=0.024)。多因素logistic回归分析提示超重/肥胖及腹型肥胖与糖尿病视网膜病变之间无显著相关性(P0.05)。在2型糖尿病患者中,伴有糖尿病视网膜病变的患者较无视网膜病变者有较低的BMI(24.3 kg/m2vs.24.9 kg/m2,P=0.001)和空腹C肽水平(1.46 ng/ml vs.1.86 ng/ml,P0.001)。将BMI按2 kg/m2进行分组,计算各组糖尿病视网膜病变的比值比(odds ratio,OR),数据显示BMI和糖尿病视网膜病变之间呈U型关系;当BMI在28-29.9 kg/m2区间时,患者有最低的糖尿病视网膜病变患病风险。而将BMI按正常、超重和肥胖进行分组,数据显示:校正性别、糖尿病诊断年龄和病程,超重患者较正常体重者有更低的任何程度的糖尿病视网膜病变(OR=0.73)、DR I-II(OR=0.76)、DR III-IV(OR=0.64)患病风险(模型1)。但进一步校正其它混杂因素如吸烟、饮酒、平均血压、TC、HDL-C、胰岛素治疗(模型2)以及进一步校正空腹C肽(模型3)后,两者的关联强度减弱甚至消失。此外,按照空腹C肽三分位数进行分层后分析发现,不同BMI类别的患者糖尿病视网膜病变患病风险相似。结论在LADA患者中,BMI与糖尿病视网膜病变之间无显著关系。在2型糖尿病患者中,超重患者较正常体重者有较低的糖尿病视网膜病变患病风险;但肥胖患者糖尿病视网膜病变发生风险与正常体重者相似。较好的胰岛功能可能是超重患者有较低糖尿病视网膜病变患病风险的主要原因。第三部分:LADA和2型糖尿病患者胰腺体积的比较及其临床意义目的比较不同类型糖尿病患者胰腺体积的变化特点,考察胰腺体积大小对不同类型糖尿病患者胰岛β细胞功能的预测价值。研究对象和方法2013年5月~2013年7月对门诊70例LADA患者和66例1型糖尿病患者完成随访。同时,选取89例我院内分泌科住院2型糖尿病患者和106例其它科室住院的血糖正常的患者作为正常对照组。上述患者均进行了上腹部CT检查,并排除恶性肿瘤和急慢性胰腺炎等疾病。使用西门子Virtuoso工作平台绘制胰腺轮廓,并计算每个层面面积(cm2)。胰腺体积即为每个层面面积之和乘以层距(5cm)。本研究采用空腹C肽(FCP)评估胰岛功能,FCP≤0.9ng/ml被定义为绝对胰岛素不足。在LADA患者中,以绝对胰岛素不足为因变量,胰腺体积为自变量拟合回归方程,绘制ROC曲线并计算ROC曲线下面积(AUC),构建绝对胰岛素不足的预测模型。结果不同类型糖尿病患者的胰腺体积均显著小于正常对照组(P0.05)。胰腺体积从大到小依次为正常对照组(64.8 cm3)、LADA(56.2 cm3)和2型糖尿病患者(54.3 cm3)、以及1型糖尿病(44.1 cm3)。LADA和2型糖尿病患者胰腺体积大小相似,但均显著大于1型糖尿病(P0.05)。在三个糖尿病亚组中,胰腺体积与性别、BMI、腰围和体表面积显著相关(P0.05)。在LADA和2型糖尿病患者中胰腺体积和空腹C肽水平呈中度相关,其偏相关系数分别为0.624(P0.001)和0.449(P0.001)。ROC曲线下面积为多变量回归分析显示,胰腺体积与LADA患者绝对胰岛素不足呈独立显著相关。ROC曲线下面积为0.82(0.72-0.92,P0.001)。根据最大约登指数(Maximum Youden index)原则,胰腺体积的最佳切点为51cm3,其相应的灵敏度和特异度分别为81%和70%。结论与正常对照组比较,不同类型糖尿病的胰腺体积均显著降低:LADA和2型糖尿病患者胰腺体积无显著性差异,但均大于1型糖尿病患者。在LADA和2型糖尿病中,胰腺体积与性别、BMI、体表面积、腰围和空腹C肽等临床指标呈中度相关。胰腺体积能较好地评估LADA患者胰岛β细胞功能。
文内图片：
图片说明：患者纳入流程图
[Abstract]:Adult delayed-type autoimmune diabetes (LADA) is a subtype of autoimmune diabetes, and its clinical characteristics are very similar to type 2 diabetes, and it is difficult to identify with type 2 diabetes. However, with the progress of the course of the disease, the rate of pancreatic islet cell failure is faster than that of type 2 diabetes, and it is different from type 2 diabetes. At the same time, the clinical characteristic of LADA is different from that of the classic type 1 diabetes. At present, there are few studies on the characteristics and risk factors of the chronic complications of LADA in China. An effective prediction model for the occurrence of chronic complications of LADA is still lacking. Although there are many studies on the physiological mechanism of the LADA, the relationship between the changes of the form of the LADA pancreas and its relationship with the clinical features, in particular the pancreatic volume, has not yet been reported on the evaluation of the function of the LADA pancreatic islet cell. The study of the relationship between the clinical characteristics of the first part of the LADA and the type 2 diabetes and the chronic complication is to compare the clinical characteristics of the two groups of patients with type 2 diabetes and the similarities and differences of the chronic complications. The risk factors of chronic complications of the two groups were further analyzed, and the prediction model of the occurrence of chronic complications was constructed. The subject and method of the study were cross-sectional study, and the data of the 6 and 975 hospitalized patients with type 2 diabetes were collected from the adult onset (diabetes diagnosis age:30-75 years) in the family in the last 10 years and the detection of the islet-related antibodies was performed. We matched 1:2 of LADA patients with type 2 diabetic patients according to the same age, gender and the same course of course, and compared the clinical features and the characteristics of chronic complications between the patients with LADA and type 2 diabetes. and further adopts the clinical indexes, including the sex, the age, the course of diabetes, the blood sugar control level (Hb, the rate of 9.0%), the hypertension, the hypertriglyceridemia, the low-density lipoprotein cholesterol blood fat and the BMI as the independent variable, and each chronic complication is the dependent variable, A logistic regression equation was fitted to construct a predictive model for the occurrence of chronic complications of diabetes, and the ROC curve was drawn. Results 384 (5.5%) patients were diagnosed as LADA. Compared with type 2 diabetes, LADA patients had lower fasting C-peptide levels (1.77 ng/ ml vs. 1.18 ng/ ml, P0.001), lower levels of systolic blood pressure, diastolic blood pressure, BMI, TG and higher levels of HDL-C (P0.05). In addition, the prevalence of metabolic syndrome and its components in patients with LADA is significantly lower than that of type 2 diabetes. The prevalence of diabetic retinopathy (12.2% vs. 21.8%, P = 0.018) and the prevalence of diabetic retinopathy (8.1% vs. 15.9%, P = 0.011) and the prevalence of diabetic retinopathy (8.1% vs. 15.9%, P = 0.011) were found in patients with type 2 diabetes in the course of diabetes. At the same time, the prevalence of these two microvascular complications in patients with LADA increased rapidly with the course of the course of the disease. There was no significant difference in the prevalence of major vascular complications (carotid plaque) in patients with type 2 diabetes. In the model of diabetic albuminuria and diabetic retinopathy, the area of the ROC curve of LADA was significantly greater than type 2 diabetes (diabetic albuminuria model: 0.75 vs. 0.67, P = 0.080; diabetic retinopathy model: 0.80 vs. 0.69, P = 0.018). However, in the diabetic large-vessel prediction model, the area of the LADA and the 2-type diabetic ROC curve was similar (P0.05). Conclusion Compared with type 2 diabetes, the prevalence of metabolic syndrome and its related components in LADA is lower, but the function of pancreatic islet is poor. In the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course In addition, the clinical features are superior to type 2 diabetes in the prediction of LADA albuminuria and retinopathy. The relationship between body mass index (BMI) and diabetic retinopathy and the possible mechanism of body mass index (BMI) in patients with LADA and type 2 diabetes mellitus were discussed in this paper. A total of 316 LADA patients and 2,533 patients with type 2 diabetes were included in the study. All patients were subject to a bilateral eye-free mydriasis and read by a professional ophthalmologist. Diabetic retinopathy is divided into the following three levels according to their severity: non-fundus lesions (non-DR), mild-to-moderate retinopathy (DRI-II), and retinal lesions that affect vision (DR III-IV); and any degree of diabetic retinopathy including DR I to IV. The body mass index (kg/ m2) was divided into three groups: normal weight (18.5% BMI25), overweight (25% BMI30), and obesity (BMI-30). The BMI18.5 kg/ m2 patient was not included in this study. Results A total of 69 patients with LADA (21.8%) and 701 (27.7%) patients with type 2 diabetes were associated with diabetic retinopathy. In LADA patients, there was no significant difference in BMI between patients with diabetic retinopathy (23.0 kg/ m2 vs. 22.8 kg/ m2, P = 0.211) compared with those without retinopathy (P = 0.211), but the waist level was slightly higher (85 cm vs.84 cm, P = 0.024). Multivariate logistic regression analysis showed no significant correlation between overweight/ obesity and abdominal obesity and diabetic retinopathy (P0.05). In patients with type 2 diabetes, patients with diabetic retinopathy had lower BMI (24.3 kg/ m2vs. 24.9 kg/ m2, P = 0.001) and fasting C-peptide levels (1.46 ng/ ml vs. 1.86 ng/ ml, P0.001) in patients with diabetic retinopathy. The ratio of BMI was 2 kg/ m2 to calculate the ratio of the ratio of the diabetic retinopathy (OR), and the data showed a U-shaped relationship between the BMI and the diabetic retinopathy. When the BMI was in the range of 28-29.9 kg/ m2, the patient had the lowest risk of diabetic retinopathy. The BMI was grouped according to normal, overweight and obesity data showing that the risk of diabetic retinopathy (OR = 0.73), DR I-II (OR = 0.76), and DR III-IV (OR = 0.64) was associated with the risk of diabetic retinopathy (OR = 0.73), DR I-II (OR = 0.76), and DR III-IV (OR = 0.64) for overweight patients with a lower level of diabetic retinopathy (OR = 0.73), DR I-II (OR = 0.76), and DR III-IV (OR = 0.64). However, further correction of other confounding factors such as smoking, alcohol consumption, average blood pressure, TC, HDL-C, insulin therapy (model 2), and further correction of fasting C-peptide (model 3), the associated strength of both decreased or even disappeared. In addition, post-stratification analysis according to the three-digit number of fasting C-peptide found that the risk of diabetic retinopathy in patients with different BMI categories was similar. Conclusion There is no significant relationship between BMI and diabetic retinopathy in patients with LADA. In patients with type 2 diabetes, patients with overweight have a lower risk of diabetic retinopathy than those of normal body weight; however, the risk of diabetic retinopathy in obese patients is similar to those of normal body weight. The better islet function may be the main cause of the risk of low diabetic retinopathy in overweight patients. The third part: The comparison of the pancreatic volume of the patients with type 2 diabetes and the clinical significance of the changes in the volume of the pancreas in different types of diabetic patients, and the prediction value of the pancreatic volume size on the function of the pancreatic islet cells in different types of diabetes. The subjects and methods were followed up in 70 LADA patients and 66 patients with type 1 diabetes from May 2013 to July 2013. In the meantime,89 patients with type 2 diabetes in our hospital and 106 other patients with normal blood glucose were selected as the normal control group. The above-mentioned patients underwent upper abdominal CT examination and ruled out the diseases such as malignant tumor and acute and chronic pancreatitis. The pancreas profile was plotted using the Siemens Outoso working platform and the area of each layer (cm2) was calculated. The volume of the pancreas is the sum of the area of each layer multiplied by the layer distance (5 cm). The study used fasting C-peptide (FCP) to assess the islet function, and FCP-0.9 ng/ ml was defined as absolute insulin deficiency. In the LADA patients, the regression equation was fitted with the absolute insulin deficiency as the dependent variable and the volume of the pancreas as the independent variable, the ROC curve was drawn and the area under the ROC curve (AUC) was calculated, and the prediction model of absolute insulin deficiency was constructed. Results The volume of pancreas in patients with different type of diabetes was significantly lower than that of normal control group (P0.05). The volume of pancreas was from large to small in the normal control group (64.8 cm3), LADA (56.2 cm3) and type 2 diabetes (54.3 cm3), and type 1 diabetes (44.1 cm3). The size of the pancreas in the patients with type 2 diabetes was similar, but was significantly higher than that of type 1 diabetes (P0.05). In the three diabetic subgroups, the volume of pancreas was significantly related to sex, BMI, waist circumference and body surface area (P0.05). In the patients with type 2 diabetes, the volume of the pancreas and the level of fasting C-peptide were moderately correlated, the partial correlation coefficient was 0.624 (P0.001) and 0.449 (P0.001), and the area under the ROC curve was a multi-variable regression analysis, and the volume of the pancreas was significantly related to the absolute insulin deficiency in the patients with LADA. The area under the ROC curve was 0.82 (0.72-0.92, P0.001). The best point of tangency of the pancreatic volume is 51 cm3, and the corresponding sensitivity and specificity are 81% and 70%, respectively. Conclusion Compared with the normal control group, the volume of pancreas of different type of diabetes is significantly lower: there is no significant difference in the volume of pancreas in the patients with type 2 diabetes, but it is greater than that of type 1 diabetes. In LADA and type 2 diabetes, the volume of pancreas was moderately correlated with clinical indicators such as sex, BMI, body surface area, waist circumference, and fasting C-peptide. The pancreatic volume can be used to evaluate the function of pancreatic islet cell in LADA patients.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R587.2
本文编号：2511118
文内图片：
图片说明：患者纳入流程图
[Abstract]:Adult delayed-type autoimmune diabetes (LADA) is a subtype of autoimmune diabetes, and its clinical characteristics are very similar to type 2 diabetes, and it is difficult to identify with type 2 diabetes. However, with the progress of the course of the disease, the rate of pancreatic islet cell failure is faster than that of type 2 diabetes, and it is different from type 2 diabetes. At the same time, the clinical characteristic of LADA is different from that of the classic type 1 diabetes. At present, there are few studies on the characteristics and risk factors of the chronic complications of LADA in China. An effective prediction model for the occurrence of chronic complications of LADA is still lacking. Although there are many studies on the physiological mechanism of the LADA, the relationship between the changes of the form of the LADA pancreas and its relationship with the clinical features, in particular the pancreatic volume, has not yet been reported on the evaluation of the function of the LADA pancreatic islet cell. The study of the relationship between the clinical characteristics of the first part of the LADA and the type 2 diabetes and the chronic complication is to compare the clinical characteristics of the two groups of patients with type 2 diabetes and the similarities and differences of the chronic complications. The risk factors of chronic complications of the two groups were further analyzed, and the prediction model of the occurrence of chronic complications was constructed. The subject and method of the study were cross-sectional study, and the data of the 6 and 975 hospitalized patients with type 2 diabetes were collected from the adult onset (diabetes diagnosis age:30-75 years) in the family in the last 10 years and the detection of the islet-related antibodies was performed. We matched 1:2 of LADA patients with type 2 diabetic patients according to the same age, gender and the same course of course, and compared the clinical features and the characteristics of chronic complications between the patients with LADA and type 2 diabetes. and further adopts the clinical indexes, including the sex, the age, the course of diabetes, the blood sugar control level (Hb, the rate of 9.0%), the hypertension, the hypertriglyceridemia, the low-density lipoprotein cholesterol blood fat and the BMI as the independent variable, and each chronic complication is the dependent variable, A logistic regression equation was fitted to construct a predictive model for the occurrence of chronic complications of diabetes, and the ROC curve was drawn. Results 384 (5.5%) patients were diagnosed as LADA. Compared with type 2 diabetes, LADA patients had lower fasting C-peptide levels (1.77 ng/ ml vs. 1.18 ng/ ml, P0.001), lower levels of systolic blood pressure, diastolic blood pressure, BMI, TG and higher levels of HDL-C (P0.05). In addition, the prevalence of metabolic syndrome and its components in patients with LADA is significantly lower than that of type 2 diabetes. The prevalence of diabetic retinopathy (12.2% vs. 21.8%, P = 0.018) and the prevalence of diabetic retinopathy (8.1% vs. 15.9%, P = 0.011) and the prevalence of diabetic retinopathy (8.1% vs. 15.9%, P = 0.011) were found in patients with type 2 diabetes in the course of diabetes. At the same time, the prevalence of these two microvascular complications in patients with LADA increased rapidly with the course of the course of the disease. There was no significant difference in the prevalence of major vascular complications (carotid plaque) in patients with type 2 diabetes. In the model of diabetic albuminuria and diabetic retinopathy, the area of the ROC curve of LADA was significantly greater than type 2 diabetes (diabetic albuminuria model: 0.75 vs. 0.67, P = 0.080; diabetic retinopathy model: 0.80 vs. 0.69, P = 0.018). However, in the diabetic large-vessel prediction model, the area of the LADA and the 2-type diabetic ROC curve was similar (P0.05). Conclusion Compared with type 2 diabetes, the prevalence of metabolic syndrome and its related components in LADA is lower, but the function of pancreatic islet is poor. In the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course In addition, the clinical features are superior to type 2 diabetes in the prediction of LADA albuminuria and retinopathy. The relationship between body mass index (BMI) and diabetic retinopathy and the possible mechanism of body mass index (BMI) in patients with LADA and type 2 diabetes mellitus were discussed in this paper. A total of 316 LADA patients and 2,533 patients with type 2 diabetes were included in the study. All patients were subject to a bilateral eye-free mydriasis and read by a professional ophthalmologist. Diabetic retinopathy is divided into the following three levels according to their severity: non-fundus lesions (non-DR), mild-to-moderate retinopathy (DRI-II), and retinal lesions that affect vision (DR III-IV); and any degree of diabetic retinopathy including DR I to IV. The body mass index (kg/ m2) was divided into three groups: normal weight (18.5% BMI25), overweight (25% BMI30), and obesity (BMI-30). The BMI18.5 kg/ m2 patient was not included in this study. Results A total of 69 patients with LADA (21.8%) and 701 (27.7%) patients with type 2 diabetes were associated with diabetic retinopathy. In LADA patients, there was no significant difference in BMI between patients with diabetic retinopathy (23.0 kg/ m2 vs. 22.8 kg/ m2, P = 0.211) compared with those without retinopathy (P = 0.211), but the waist level was slightly higher (85 cm vs.84 cm, P = 0.024). Multivariate logistic regression analysis showed no significant correlation between overweight/ obesity and abdominal obesity and diabetic retinopathy (P0.05). In patients with type 2 diabetes, patients with diabetic retinopathy had lower BMI (24.3 kg/ m2vs. 24.9 kg/ m2, P = 0.001) and fasting C-peptide levels (1.46 ng/ ml vs. 1.86 ng/ ml, P0.001) in patients with diabetic retinopathy. The ratio of BMI was 2 kg/ m2 to calculate the ratio of the ratio of the diabetic retinopathy (OR), and the data showed a U-shaped relationship between the BMI and the diabetic retinopathy. When the BMI was in the range of 28-29.9 kg/ m2, the patient had the lowest risk of diabetic retinopathy. The BMI was grouped according to normal, overweight and obesity data showing that the risk of diabetic retinopathy (OR = 0.73), DR I-II (OR = 0.76), and DR III-IV (OR = 0.64) was associated with the risk of diabetic retinopathy (OR = 0.73), DR I-II (OR = 0.76), and DR III-IV (OR = 0.64) for overweight patients with a lower level of diabetic retinopathy (OR = 0.73), DR I-II (OR = 0.76), and DR III-IV (OR = 0.64). However, further correction of other confounding factors such as smoking, alcohol consumption, average blood pressure, TC, HDL-C, insulin therapy (model 2), and further correction of fasting C-peptide (model 3), the associated strength of both decreased or even disappeared. In addition, post-stratification analysis according to the three-digit number of fasting C-peptide found that the risk of diabetic retinopathy in patients with different BMI categories was similar. Conclusion There is no significant relationship between BMI and diabetic retinopathy in patients with LADA. In patients with type 2 diabetes, patients with overweight have a lower risk of diabetic retinopathy than those of normal body weight; however, the risk of diabetic retinopathy in obese patients is similar to those of normal body weight. The better islet function may be the main cause of the risk of low diabetic retinopathy in overweight patients. The third part: The comparison of the pancreatic volume of the patients with type 2 diabetes and the clinical significance of the changes in the volume of the pancreas in different types of diabetic patients, and the prediction value of the pancreatic volume size on the function of the pancreatic islet cells in different types of diabetes. The subjects and methods were followed up in 70 LADA patients and 66 patients with type 1 diabetes from May 2013 to July 2013. In the meantime,89 patients with type 2 diabetes in our hospital and 106 other patients with normal blood glucose were selected as the normal control group. The above-mentioned patients underwent upper abdominal CT examination and ruled out the diseases such as malignant tumor and acute and chronic pancreatitis. The pancreas profile was plotted using the Siemens Outoso working platform and the area of each layer (cm2) was calculated. The volume of the pancreas is the sum of the area of each layer multiplied by the layer distance (5 cm). The study used fasting C-peptide (FCP) to assess the islet function, and FCP-0.9 ng/ ml was defined as absolute insulin deficiency. In the LADA patients, the regression equation was fitted with the absolute insulin deficiency as the dependent variable and the volume of the pancreas as the independent variable, the ROC curve was drawn and the area under the ROC curve (AUC) was calculated, and the prediction model of absolute insulin deficiency was constructed. Results The volume of pancreas in patients with different type of diabetes was significantly lower than that of normal control group (P0.05). The volume of pancreas was from large to small in the normal control group (64.8 cm3), LADA (56.2 cm3) and type 2 diabetes (54.3 cm3), and type 1 diabetes (44.1 cm3). The size of the pancreas in the patients with type 2 diabetes was similar, but was significantly higher than that of type 1 diabetes (P0.05). In the three diabetic subgroups, the volume of pancreas was significantly related to sex, BMI, waist circumference and body surface area (P0.05). In the patients with type 2 diabetes, the volume of the pancreas and the level of fasting C-peptide were moderately correlated, the partial correlation coefficient was 0.624 (P0.001) and 0.449 (P0.001), and the area under the ROC curve was a multi-variable regression analysis, and the volume of the pancreas was significantly related to the absolute insulin deficiency in the patients with LADA. The area under the ROC curve was 0.82 (0.72-0.92, P0.001). The best point of tangency of the pancreatic volume is 51 cm3, and the corresponding sensitivity and specificity are 81% and 70%, respectively. Conclusion Compared with the normal control group, the volume of pancreas of different type of diabetes is significantly lower: there is no significant difference in the volume of pancreas in the patients with type 2 diabetes, but it is greater than that of type 1 diabetes. In LADA and type 2 diabetes, the volume of pancreas was moderately correlated with clinical indicators such as sex, BMI, body surface area, waist circumference, and fasting C-peptide. The pancreatic volume can be used to evaluate the function of pancreatic islet cell in LADA patients.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R587.2
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