2018 年第 12 期 第 13 卷

新疆维吾尔族与汉族初诊1型糖尿病患儿血清25-羟维生素D3水平和相关抗体检出情况以及多个指标的相互关系

Relation among serum 25-hydroxyvitamin D3, diabetes related antibodies and biological indicators in Xinjiang Uygur and Han children with newly diagnosed type 1 diabetes mellitus

作者：郭红余亮米克拉依·加帕尔程云仙冯瑞华李奇凤罗新辉

英文作者：

单位：830001乌鲁木齐，新疆维吾尔自治区人民医院儿科

英文单位：

关键词：1型糖尿病；25-羟维生素D3；胰岛自身抗体；C肽

英文关键词：

• 摘要：

• 【摘要】目的    观察新疆维吾尔族与汉族初诊1型糖尿病（T1DM）患儿血清25-羟维生素D3水平和相关抗体［谷氨酸脱羧酶抗体(GADA)、抗酪氨酸磷酸酶抗体(IA2)、抗胰岛细胞抗体(ICA)、抗胰岛素自身抗体(IAA)、锌转运8自身抗体(ZnT-8)］检出情况以及多个指标的临床关系。方法    选取2015年6月至2018年6月于新疆维吾尔自治区人民医院儿科初次诊断的T1DM患儿88例作为T1DM组，选取同期健康查体的体重指数、空腹血糖、C肽水平正常的儿童100名作为正常对照组。比较2组临床资料及常规生化指标、血清25-羟维生素D3水平、糖尿病相关抗体检出情况及C肽水平。结果    T1DM组的血清25-羟维生素D3浓度低于正常对照组［（15±8）μg/L比（39±13）μg/L］，差异有统计学意义（P<0.05）。维吾尔族患儿的血清25-羟维生素D3水平稍高于汉族患儿，但差异无统计学意义（P>0.05）。88例T1DM患儿糖尿病相关抗体阳性59例，阳性率为67.0%，汉族患儿糖尿病相关抗体阳性率明显高于维吾尔族患儿［94.3%（33/35）比49.0%（26/53）］，差异有统计学意义（P<0.05）。T1DM患儿ICA及IAA的检出率高。T1DM患儿25-羟维生素D3缺乏组的 GADA、IA2、ICA、IAA、ZnT-8阳性率明显高于不足组和充足组，差异均有统计学意义（均P<0.01）。抗体数量的分布以携带3种抗体的患儿例数最多，差异有统计学意义（P<0.05）；携带3、4种抗体患儿空腹C肽水平明显低于携带0、2种抗体患儿，差异有统计学意义（P<0.05）。结论    T1DM患儿血清25-羟维生素D3缺乏，胰岛自身抗体ICA及IAA的检出率高，25-羟维生素D3可能会影响ICA及IAA的产生及检出率。汉族患儿抗体总检出率高于维吾尔族，提示T1DM的发生除自身免疫主要因素外，尚存在其他原因。胰岛自身抗体种类的数量与C肽水平呈负相关。

• 【Abstract】Objective    To analyze the relation among serum 25-hydroxyvitamin D3, diabetes related antibodies［glutamic acid decarboxylase antibody(GADA), tyrosine phosphatase antibody (IA2), islet cell antibody(ICA), insulin autoantibody(IAA), zinc transport 8 autoantibody(ZnT-8)］ and biological indicators in Xinjiang Uygur and Han children with newly diagnosed type 1 diabetes mellitus(T1DM). Methods    From June 2015 to June 2018, 88 children who were initially diagnosed of T1DM in People′s Hospital of Xinjiang Uygur Autonomous Region were enrolled as T1DM group; 100 healthy children with normal body mass index, fasting blood glucose and C-peptide were enrolled as control group. Clinical data, biochemical indexes, serum 25-hydroxyvitamin D3, diabetes related antibodies and C-peptide were analyzed. Results    Serum 25-hydroxyvitamin D3 level in the T1DM group was significantly lower than that in the control group［（15±8）μg/L vs （39±13）μg/L］（P<0.05）. Serum 25-hydroxyvitamin D3 level in Uygur children with T1DM was higher than that in Han children(P>0.05). The positive rate of diabetes related antibodies in 88 T1DM children was 67.0%（n=59）. The positive rate of diabetes related antibodies in Han children was significantly higher than that in Uygur children［94.3%（33/35） vs 49.0%（26/53）］(P<0.05). The detection rates of ICA and IAA in T1DM children were high. The positive rates of GADA, IA2, ICA, IAA and ZnT-8 in the 25-hydroxyvitamin D3 deficiency group were higher than those in the 25-hydroxyvitamin D3 sufficiency group(P<0.01). T1DM children carrying 3 antibodies took the majority(P<0.05). C-peptide levels in patients carrying 3 or 4 antibodies were lower than those in patients carrying 0 or 2 antibodies(P<0.05). Conclusions    Children with T1DM have deficiency of serum 25-hydroxyvitamin D3 and high detection rates of ICA and IAA. The antibody detection rate in Han children is higher than that in uygur children, indicating that T1DM may have other causes besides autoimmunity. There is a negative correlation between the number of islet autoantibodies and the level of C-peptide.