ADA 2013：周智广：中国自身免疫性糖尿病数量居全球首位

【导语】2013年第73届美国糖尿病协会科学年会(ADA 2013)于6月21日~25日在美国芝加哥隆重举办。在ADA 2013年会上，中南大学湘雅二医院周智广教授发表一项口头报告“中国自身免疫性糖尿病患病率：一项全国性人群调查”，指出中国自身免疫性糖尿病人群数量在全球范围内居首位。

　　背景和目标：中国国家糖尿病和代谢紊乱研究[N Engl J Med 2010]于2007年6月至2008年5月间进行，是一项横断面研究，研究显示中国年龄标准化糖尿病患病率为9.7%，说明在中国有9240万成年糖尿病患者。借助这项研究，我们通过筛查胰岛自身抗体调查了中国自身免疫性糖尿病患病率。

　　方法：研究纳入的全国代表性样本由来自中国14个省和直辖市的46239例年龄20岁及以上的成人组成。参与者禁食一夜后行口服葡萄糖耐量试验(OGTT)。根据自我报告确定参与者既往的糖尿病诊断。我们进一步随机选择1002例OGTT阴性的受试者作为对照组，应用胰岛自身抗体标准化检测项目
(IASP)2012年验证方法，在4671例OGTT确诊的糖尿病受试者中集中筛查谷氨酸脱羧酶抗体(GADA)、蛋白酪氨酸磷酸酯酶样蛋白自身抗体(IA2A)、以及锌转运体8自身抗体(ZnT8A)。

　　结果：通过筛选3种胰岛自身抗体，发现自身免疫性糖尿病的患病率占总糖尿病人群的6.6%(310/4671)，提示中国约有610万自身免疫性糖尿病成人患者。其中GADA、IA2A和ZnT8A阳性率分别为4.1%(190/4671)、1.4%(65/4671)和1.7%(78/4671)。本次报告的基于人群的GADA阳性率显著低于我们以往在LADA中国研究报告的基于门诊的数据[Diabetes 2013]。

　　结论：自身免疫性糖尿病在中国普遍流行。我们的原始数据显示中国自身免疫性糖尿病人群数量在全球范围内居首位。

【研究摘要】

Prevalence of Autoimmune Diabetes in China: A Nationwide Population-Based Survey

Zhiguang Zhou MD, PhD Central South University

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.