Chronic diabetic complications in patients with MODY3 diabetes
Chronic diabetic complications in patients with MODY3 diabetes
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DOI：
10.1007/s001250050931
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发表时间：
1998-04-01
期刊：
影响因子：
8.2
通讯作者：
Groop, L
中科院分区：
文献类型：
--
作者：
Isomaa, B;Henricsson, M;Groop, L
MODY 3糖尿病是由12号染色体上的肝细胞核因子let基因（HNF-1 α）突变引起的，代表了芬兰相对常见的单基因糖尿病形式。发病年龄从10岁到60岁不等，但对疾病的自然病程，特别是糖尿病相关慢性并发症的发展知之甚少。遗传标记的可用性现在允许描述疾病的临床过程。为了检测MODY 3中慢性糖尿病并发症的患病率，我们检查了57名携带HNF-1 α突变的携带者是否存在微血管和大血管并发症。34%的MODY患者有轻度的非增殖性或增殖性视网膜病变，13%有重度的非增殖性或增殖性视网膜病变;这个数字与胰岛素依赖型糖尿病（IDDM）和非胰岛素依赖型糖尿病（NIDDM）患者的数字没有差异，这些患者在病程和血糖控制方面相匹配，但在年龄方面没有差异。MODY 3与IDDM或NIDDM患者之间微量白蛋白尿的患病率也没有差异（19 vs 24和23%）。观察到神经病变的频率与先前在IDDM中报告的频率相同。高血压在MODY 3和IDDM中的发生率低于NIDDM（24.5%和19% vs 53.7%; p < 0.001）。冠心病在MODY 3中比在IDDM中更常见（16vs4.5%; p < 0.02），但比在老年NIDDM患者中更少见（33.3%; p < 0.02）。在多元逻辑回归分析中，血糖控制不良是视网膜病变（p = 0.03）、微量白蛋白尿（p < 0.04）和神经病变（p = 0.03）的独立危险因素。总之，MODY 3型糖尿病患者与IDDM和NIDDM患者的微血管病变并发症发生率相同，且与血糖控制不良密切相关。
MODY3 diabetes, which is caused by a mutation in the hepatocyte nuclear factor-let gene (HNF-1 alpha) on chromosome 12, represents a relatively common monogenic form of diabetes in Finland. Age at onset of the disease can vary from 10 to 60 years, but little is known about the natural course of the disease, particularly the development of diabetes-related chronic complications. The availability of genetic markers now allows description of the clinical course of the disease. In order to examine the prevalence of chronic diabetic complications in MODY3, we examined 57 carriers with HNF-1 alpha mutations for the presence of micro-and macrovascular complications. Thirty-four percent of the MODY patients had mild and 13 % had severe non-proliferative or proliferative retinopathy; this figure did not differ from the figures in insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) patients matched for duration and glycaemic control but not for age. Neither did the prevalence of microalbuminuria differ between MODY3 and IDDM or NIDDM patients (19 vs 24 and 23 %). Neuropathy was observed with the same frequency as previously reported in IDDM. Hypertension was less frequent in MODY3 and IDDM than in NIDDM (24.5 and 19 vs 53.7%; p < 0.001). Coronary heart disease was more common in MODY3 than in IDDM (16 vs 4.5 %; p < 0.02) but less common than in the older NIDDM, patients (33.3 %; p < 0.02). In a multiple logistic regression analysis, poor glycaemic control was an independent risk factor for retinopathy (p = 0.03), microalbuminuria (p < 0.04) and neuropathy (p = 0.03). In conclusion, microangiopathic complications are observed with the same frequency in patients with MODY3 diabetes as in IDDM and NIDDM and are strongly related to poor glycaemic control.