diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12843diaendo-12843Research ArticleОригинальные исследованияOriginal StudiesУровень С-пептида и распространенность панкреатических аутоантител у детей с сахарным диабетом 1 типа при разной длительности заболеванияC-peptide levels and the prevalence of islets autoantibodies in children with type 1 diabetes mellitus with different duration of the diseasehttps://orcid.org/0000-0003-0123-8857РоманенковаЕ. М.RomanenkovaE. M.

Романенкова Елизавета Михайловна 

117036, Москва, ул. Дм. Ульянова, д. 11

Researcher ID: AAB-7186-2021;

eLibrary SPIN: 6190-0118

Elizaveta M. Romanenkova, MD

11 Dm. Ulyanova street, 117036 Moscow

Researcher ID: AAB-7186-2021;

eLibrary SPIN: 6190-0118

romanenkovae@list.ruhttps://orcid.org/0000-0001-7021-1151ЕреминаИ. А.EreminaI. A.

Еремина Ирина Александровна, кандидат медицинских наук

Москва

Researcher ID: S-3979-2016;

Scopus Author ID: 6701334405;

eLibrary SPIN: 9411-4710

Irina A. Eremina, MD, PhD

Moscow

Researcher ID: S-3979-2016;

Scopus Author ID: 6701334405;

eLibrary SPIN: 9411-4710

ieremina58@gmail.comhttps://orcid.org/0000-0001-7821-3979ТитовичЕ. В.TitovichE. V.

Титович Елена Витальевна, кандидат медицинских наук

Москва

Researcher ID: AAO-2567-2020;

Scopus Author ID: 6507024916;

eLibrary SPIN: 7994-0797

Elena V. Titovich, MD, PhD

Moscow

Researcher ID: AAO-2567-2020;

Scopus Author ID: 6507024916;

eLibrary SPIN: 7994-0797

lenatitovich@mail.ruhttps://orcid.org/0000-0002-8181-5572СечкоЕ. А.SechkoE. A.

Сечко Елена Александровна, кандидат медицинских наук

Москва

Researcher ID: S-4114-2016;

Scopus Author ID: 55880018700;

eLibrary SPIN: 4608-5650

Elena A. Sechko, MD, PhD

Moscow

Researcher ID: S-4114-2016;

Scopus Author ID: 55880018700;

eLibrary SPIN: 4608-5650

elena.sechko@bk.ruНиканкинаЛ. В.NikankinaL. V.

Никанкина Лариса Вячеславовна, кандидат медицинских наукМоскваResearcher ID: S-4114-2016;Scopus Author ID: 55880018700;eLibrary SPIN: 4608-5650

Larisa V. Nikankina, MD, PhD

Moscow

Researcher ID: S-4114-2016;

Scopus Author ID: 55880018700;

eLibrary SPIN: 4608-5650

lnikankina@mail.ruhttps://orcid.org/0000-0002-5507-4627ПетерковаВ. А.PeterkovaV. A.

Петеркова Валентина Александровна, доктор медицинских наук, профессор, академик РАНМоскваe-library SPIN: 4009-2463

Valentina A. Peterkova, MD, PhD, Professor, Academician of Russian Academy of Sciences

Moscow

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peterkovava@hotmail.comhttps://orcid.org/0000-0001-9621-5732БезлепкинаО. Б.BezlepkinaO. B.

Безлепкина Ольга Борисовна, доктор медицинских наукМоскваResearcher ID: B-6627-2017;Scopus Author ID: 6507632848;eLibrary SPIN: 3884-0945

Olga B. Bezlepkina, MD, PhD

Moscow

Researcher ID: B-6627-2017;

Scopus Author ID: 6507632848;

eLibrary SPIN: 3884-0945

olgabezlepkina@mail.ruhttps://orcid.org/0000-0002-4316-8546ЛаптевД. Н.LaptevD. N.

Лаптев Дмитрий Никитич, доктор медицинских наук

Москва

Researcher ID: O-1826-2013;

Scopus Author ID: 24341083800;

e-library SPIN: 2419-4019

Dmitry N. Laptev, MD, PhD

Moscow

Researcher ID: O-1826-2013;

Scopus Author ID: 24341083800;

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laptevdn@ya.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation202208042022252155165Copyright © Романенкова Е.М., Еремина И.А., Титович Е.В., Сечко Е.А., Никанкина Л.В., Петеркова В.А., Безлепкина О.Б., Лаптев Д.Н., 20222022Романенкова Е.М., Еремина И.А., Титович Е.В., Сечко Е.А., Никанкина Л.В., Петеркова В.А., Безлепкина О.Б., Лаптев Д.Н.Romanenkova E.M., Eremina I.A., Titovich E.V., Sechko E.A., Nikankina L.V., Peterkova V.A., Bezlepkina O.B., Laptev D.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12843ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Сахарный диабет 1 типа (СД1) характеризуется развитием абсолютной недостаточности инсулина, однако у некоторых пациентов остаточная секреция инсулина может сохраняться длительное время. Оценка уровня С-пептида полезна для дифференциальной диагностики типа СД в сложных случаях, может использоваться для оценки резерва поджелудочной железы как в клинической практике, так и в клинических исследованиях.

ЦЕЛЬ

ЦЕЛЬ. Оценить уровень С-пептида и распространенность панкреатических аутоантител (Ат) у детей с СД1 при разной длительности заболевания и выявить факторы, ассоциированные с сохранной секрецией С-пептида.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. Одноцентровое одномоментное исследование, включающее данные 703 детей с СД1, госпитализированных в ФГБУ «НМИЦ эндокринологии» в 2016–2020 гг., у которых исследовался уровень С-пептида и выявлен положительный титр одного или более специфических Ат (к транспортеру цинка (ZnT8), тирозинфосфатазе (IA-2), глутаматдекарбоксилазе (GAD), цитоплазматическим структурам β-клеток (ICA), антиинсулиновых Ат (IAA)). ­Пациенты были распределены на 3 группы по длительности СД1: 1-я — <1 года, 2-я — от 1 до 5 лет, 3-я — >5 лет.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Медиана уровня С-пептида натощак в 1-й группе составила 0,6 нг/мл [0,27; 1,09]; во 2-й — 0,2 нг/мл [0,01; 0,8]; в 3-й — 0,01 нг/мл [0,01; 0,037]. Сохранная секреция С-пептида (>0,6 нг/мл) определялась в 1-й группе в 51,4%, во 2-й — в 31,4%, в 3-й — в 11,4% случаев. У пациентов с ожирением чаще определялся уровень С-пептида выше 1,1 нг/мл в первый год заболевания (65,2%) и при длительности 1–5 лет (35,7%) по сравнению с детьми с нормальным (18,5 и 14,5%) и избыточным весом (15,7 и 19%), p<0,01. Выявлена отрицательная зависимость между уровнем С-пептида и длительностью СД1 (r=-0,489; p=0,000), суточной дозой инсулина (r=-0,637; p=0,000); положительная ассоциация выявлена с возрастом диагностики СД1 (r=0,547; p=0,000). Частота выявления одного вида Ат в общей группе составила 29,5%, 2 видов — 33,6%, 3 и более — 36,9%. Распространенность IA-2, ZnT8 снижалась с увеличением длительности заболевания (p<0,05 и p<0,01), а частота выявления ICA увеличивалась (p<0,01). Ассоциации между видом, количеством, титром Ат и уровнем С-пептида, длительностью СД1 и возрастом манифестации заболевания не получено.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Уровень С-пептида у детей с СД1 в первые 5 лет от манифестации значимо выше при более старшем возрасте диагностики заболевания СД и наличии ожирения. Частота выявления IA-2, ZnT8 снижается с увеличением длительности заболевания СД1, а частота выявления ICA увеличивается. Не выявлено ассоциации между уровнем С-пептида и видом, количеством и титром Ат.

BACKGROUND

BACKGROUND: Type 1 diabetes mellitus (T1DM) is characterized by the development of absolute insulin deficiency. In some patients residual insulin secretion may persist for a long time. C-peptide is a widely used to measure the pancreatic beta cells function, in clinical practice and in research studies.

AIM

AIM: To assess C-peptide levels and presence of islets autoantibodies (Ab) in children with different duration of T1DM and to identify factors associated with the preserved secretion.

MATERIALS AND METHODS

MATERIALS AND METHODS: Single-center cross-sectional study including data from 703 cases of children with T1DM, examined in the Endocrinology Research Center in 2016-2020, who was underwent a study of C-peptide levels and was positive for one or more islets antibodies (ZnT8, IA-2, GAD, ICA, IAA). There were 3 groups of patients: 1st — T1DM duration < 1 year, 2nd — from 1 to 5 years, 3rd — > 5 years.

RESULTS

RESULTS: The median of the fasting C-peptide level in the 1st group was 0.6 ng/ml [0.27; 1.09]; in the 2nd group — 0.2 ng/ml [0.01; 0.8]; in the 3rd group — 0.01 ng/ml [0.01; 0.037]. The preserved secretion of C-peptide (> 0.6 ng/ml) was determined in 51.4% in the 1st group, in 31.4% — in the 2nd group and in 11.4% in the 3rd group. In patients with obesity during the first year from the T1DM diagnosis C-peptide levels above 1.1 ng/ml was determined significantly more often (65.2%), as well as at the period of 1 to 5 years of the disease (35.7%), compared with children with normal BMI (18.5% and 14.5%, respectively) or overweight (15.7% and 19%, respectively), p <0.01. A negative correlation was found between C-peptide levels and the duration of T1DM (r = -0.489, p = 0.000), the daily dose of insulin (r = -0.637, p = 0.000), a positive association was found with the age of diagnosis of T1DM (r = 0.547, p = 0.000). The frequency of the presence of one type of islets autoantibodies in all groups was 29.5%, 2 types — 33.6%, 3 and more types — 36.9%. The titer of IA-2, ZnT8 decreased with the disease duration (p <0.05 and p <0.01, respectively), while the titer of ICA increased (p <0.01). No associations between the types, number, antibodies titer and C-peptide levels, age of disease manifestation were found.

CONCLUSION

CONCLUSION: C-peptide levels in children with T1DM in groups with older age at diagnosis and with obesity is significantly higher for the first 5 years of the disease. The study have shown the titer of IA-2, ZnT8 is decreasing with the disease duration, in turn, the frequency of detection of ICA increases. No association between C-peptide levels and the type, number and titer of antibodies were found.

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The authors declare that there are no conflicts of interest present.