发病时的随机 C 肽和胰岛抗体可预测小儿糖尿病患者的 β 细胞功能轨迹和胰岛素依赖性。

IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Practice Pub Date : 2024-10-03 DOI:10.1016/j.eprac.2024.09.116
Mustafa Tosur, Saima Deen, Xiaofan Huang, Serife Uysal, Marcela Astudillo, Richard A Oram, Maria J Redondo, Farook Jahoor, Ashok Balasubramanyam
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引用次数: 0

摘要

背景:鉴定儿童糖尿病的预后生物标志物对精准医疗非常重要:我们评估了C肽和胰岛自身抗体是否有助于预测新发糖尿病患儿的自然病史:我们采用 Aβ 分类系统("A+":胰岛自身抗体阳性;"β+":诊断时随机血清 C 肽≥1.3 ng/mL)对 72 名新发糖尿病患儿进行了前瞻性研究(中位随访时间:8 个月)。在确诊后 3-12 周(V1)和 6-12 个月(V2),用餐后 2 小时/受刺激尿 C 肽-肌酐比值(UCPCR)对β细胞功能进行纵向评估。我们获得了每位参与者的 1 型糖尿病遗传风险评分(T1D GRS2),并比较了基线时的特征和 V2 时的临床结果:结果:组群中 50%为男性。种族分布为白人占 76.4%,黑人占 20.8%,亚裔或其他种族占 2.8%。46.5%的参与者为西班牙裔。中位年龄(Q1-Q3)为 12.4(8.3-14.5)岁。Aβ 亚组频率为 46 A+β-(63.9%)、1 A-β-(1.4%)、4 A+β+(5.6%)和 21 A-β+(29.2%)。基线血清 C 肽与 UCPCR 在 V1(r=0.36,p=0.002)和 V2(r=0.47,pConclusions:诊断时的C肽和胰岛自身免疫定义了不同的表型,可预测6-12个月后不同种族/族裔新发糖尿病患儿的β细胞功能和胰岛素依赖性。
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Random C-Peptide and Islet Antibodies at Onset Predict β Cell Function Trajectory and Insulin Dependence in Pediatric Diabetes.

Objective: Identification of prognostic biomarkers in pediatric diabetes is important for precision medicine. We assessed whether C-peptide and islet autoantibodies are useful to predict the natural history of children with new-onset diabetes.

Methods: We prospectively studied 72 children with new-onset diabetes (median follow-up: 8 months) by applying the Aβ classification system ("A+": islet autoantibody positive, "β+": random serum C-peptide ≥1.3 ng/mL at diagnosis). Beta-cell function was assessed longitudinally with 2 hours postprandial/stimulated urinary C-peptide-to-creatinine ratio (UCPCR) 3-12 weeks (V1) and 6 to 12 months after diagnosis (V2). We obtained a type 1 diabetes genetic risk score for each participant, and compared characteristics at baseline, and clinical outcomes at V2.

Results: The cohort was 50% male. Racial distribution was 76.4% White, 20.8% Black, and 2.8% Asian or other races. A total of 46.5% participants were Hispanic. Median age (Q1-Q3) was 12.4 (8.3-14.5) years. The Aβ subgroup frequencies were 46 A+β-(63.9%), 1 A-β-(1.4%), 4 A+β+(5.6%), and 21 A-β+(29.2%). Baseline serum C-peptide correlated with UCPCR at both V1 (r = 0.36, P = .002) and V2 (r = 0.47, P < .001). There were significant subgroup differences in age, race, frequency of diabetic ketoacidosis, and type 1 diabetes genetic risk score (P < .01). At V2, the 2 β-subgroups had lower UCPCR and higher hemoglobin A1c compared with the 2 β+ subgroups (P < .001 and P = .02, respectively). Thirty-eight percent of A-β+ but none of the other subgroups were insulin-independent at V2 (P < .001).

Conclusion: C-peptide and islet autoimmunity at diagnosis define distinct phenotypes and predict beta-cell function and insulin dependence 6 to 12 months later in racially/ethnically diverse children with new-onset diabetes.

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来源期刊
Endocrine Practice
Endocrine Practice ENDOCRINOLOGY & METABOLISM-
CiteScore
7.60
自引率
2.40%
发文量
546
审稿时长
41 days
期刊介绍: Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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