周智廣：中國自身免疫性糖尿病流行形勢嚴峻

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從2007年6月至2008年5月進行的中國國家糖尿病和代謝紊亂研究[N Engl J Med 2010]是一項橫斷面研究，報道稱中國年齡標準化糖尿病患病率為9.7%，說明在中國有9240萬成年糖尿病患者。根據這項研究，來自中南大學湘雅二醫院周智廣教授及其團隊進行了一項研究，通過篩選胰島自身抗體調查中國自身免疫性糖尿病的患病率。該研究發現中國擁有世界范圍內最大的自身免疫性糖尿病人群。

該研究中，由來自中國14個省和直轄市的46239例年齡20歲及以上的成人組成的全國代表性樣本參與了這項研究。受試者在空腹后進行口服葡萄糖耐量試驗（OGTT）。根據自我匯報確定既往糖尿病診斷。該研究進一步隨機選擇1002例OGTT陰性的受試者作為對照組，并集中在4671例OGTT確診的糖尿病受試者中，通過胰島自身抗體標準化計劃（IASP）2013年驗證的方法篩選谷氨酸脫羧酶抗體（GADA）、蛋白酪氨酸磷酸酯酶樣蛋白自身抗體（IA2A）、以及鋅轉運體8自身抗體（ZnT8A）。

該研究結果表明，通過篩選3種胰島自身抗體，發現自身免疫性糖尿病的患病率占糖尿病人群的6.6%（310/4671），提示在中國有大約610萬成年人伴有自身免疫性糖尿病。在糖尿病患者中，GADA、IA2A和ZnT8A陽性率分別為4.1%（190/4671）、1.4%（65/4671）和1.7%（78/4671）。人群中GADA陽性率顯著低于之前報道的來自臨床研究的數據[Diabetes 2013]。

該研究發現，自身免疫性糖尿病在中國是普遍的。原始數據顯示中國擁有世界范圍內最大的自身免疫性糖尿病人群。

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Background and objectives: The China National Diabetes and Metabolic Disorders Study [N Engl J Med 2010] from June 2007 through May 2008 was a cross-sectional study reported that the age-standardized prevalences of total diabetes were 9.7% accounting for 92.4 million adults with diabetes in China. Taking advantage of this study we aimed to investigate the prevalence of autoimmune diabetes in China by screening islet autoantibodies.

Methods: A nationally representative sample of 46 239 adults 20 years of age or older from 14 provinces and municipalities participated in the study. After an overnight fast participants underwent an oral glucose-tolerance test(OGTT). Previously diagnosed diabetes was determined on the basis of self-report. We further randomly selected 1002 OGTT negative subjects as control and screened glutamic acid decarboxylase antibodies(GADA) protein tyrosine phosphatase-like protein autoantibodies (IA2A) and zinc transporter isoform 8 autoantibodies (ZnT8A) centrally in 4671 OGTT confirmed diabetic subjects by Islets Autoantibody Standardization Program (IASP) 2012 validated methods.

Results: By screening the 3 islet autoantibodies we found that the prevalence of autoimmune diabetes taking account of 6.6% (310/4671) of the diabetes population which suggest about 6.1 million adults with autoimmune diabetes in China. Among them the positivity of GADA IA2A and ZnT8A is 4.1%(190/4671) 1.4%(65/4671) and 1.7%(78/4671) respectively. The population based GADA positivity is obviously lower than the data from clinic based study we reported before [Diabetes 2013]

Conclusion: Autoimmune diabetes is prevalent in Chinese. Our raw data showed that China has the biggest autoimmne diabetes population around the world.

編輯： 葛根    來源：丁香園