周智广：中国自身免疫性糖尿病流行形势严峻
从2007年6月至2008年5月进行的中国国家糖尿病和代谢紊乱研究[N Engl J Med 2010]是一项横断面研究，报道称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。根据这项研究，来自中南大学湘雅二医院周智广教授及其团队进行了一项研究，通过筛选胰岛自身抗体调查中国自身免疫性糖尿病的患病率。该研究发现中国拥有世界范围内最大的自身免疫性糖尿病人群。
该研究中，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的全国代表性样本参与了这项研究。受试者在空腹后进行口服葡萄糖耐量试验（OGTT）。根据自我汇报确定既往糖尿病诊断。该研究进一步随机选择1002例OGTT阴性的受试者作为对照组，并集中在4671例OGTT确诊的糖尿病受试者中，通过胰岛自身抗体标准化计划（IASP）2013年验证的方法筛选谷氨酸脱羧酶抗体（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）。
该研究结果表明，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糖尿病人群的6.6%（310/4671），提示在中国有大约610万成年人伴有自身免疫性糖尿病。在糖尿病患者中，GADA、IA2A和ZnT8A阳性率分别为4.1%（190/4671）、1.4%（65/4671）和1.7%（78/4671）。人群中GADA阳性率显著低于之前报道的来自临床研究的数据[Diabetes 2013]。
该研究发现，自身免疫性糖尿病在中国是普遍的。原始数据显示中国拥有世界范围内最大的自身免疫性糖尿病人群。
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.
ADA是美国糖尿病学会 (Americn Diabetos Association)的缩写，美国糖尿病协会县美国重要的非赢利性卫生姐织，旨在提供有关糖尿病的研究进展和信息，促进糖尿病的科研、教育、诊疗等，关注一切与糖尿病有关的事务。