一例ABCC8 基因突变致青少年起病的成人型糖尿病12 亚型家系报道并文献复习

A family pedigree with ABCC8 gene mutation causing MODY12 with adolescent onset: A case report and literature review

  • 摘要: 背景 青少年起病的成人型糖尿病(Maturity-Onset Diabetes of the Young,MODY)是一类单基因糖尿病(Diabetes Mellitus,DM),MODY12 是罕见亚型,目前国内报道较少。目的 探讨MODY12 亚型的临床特点及诊治经验,以提高对该病的认识及诊治水平。方法 回顾性分析一例ATP 结合盒转运子亚家族C成员8(ATP-Binding Cassette subfamily C member8,ABCC8)基因突变所致MODY12 亚型患者的临床资料并结合文献进行总结。结果 患者为32 岁女性,BMI 22.06 kg/m2,因胰腺炎住院时检查发现空腹血糖11.99 mmol/L,随机血糖21.07 mmol/L,糖化血红蛋白(Glycosylated Hemoglobin,HbA1c) 9.3%,空腹胰岛素15.112 μU/mL,餐后峰值胰岛素55.747 μU/mL,空腹C肽0.49 ng/mL,餐后峰值C肽3.04 ng/mL,糖尿病自身抗体均阴性,疑诊特殊类型糖尿病。通过对患者家系基因组DNA进行全外显子组捕获和测序,并使用Sanger 测序法验证其亲属信息,发现患者及其父亲携带ABCC8(NM_000352.6)c.824G>A(p.Arg275Gln)杂合突变,多个生物信息学软件预测均提示该变异为有害突变。患者原以基础胰岛素联合米格列醇治疗,基因诊断明确后改用小剂量磺脲类药物(格列美脲1 mg/d)降糖,随访血糖控制理想。结论 对于中青年起病的糖尿病患者,如糖尿病自身抗体阴性、胰岛功能尚可、胰岛素抵抗不明显,要注意MODY的可能,基因检测有助于明确诊断。对于确诊为MODY12 的患者,改用小剂量磺脲类药物治疗可以取得良好血糖控制而避免不必要的长期胰岛素注射治疗。

     

    Abstract: Background Maturity-onset diabetes of the young (MODY) is a form of monogenic diabetes mellitus (DM). MODY12 is a rare subtype, with few cases reported in China to date.Objective To explore the clinical characteristics of MODY12, so as to enhance the understanding and management of this condition.Methods A retrospective analysis was conducted on the clinical data about a patient with MODY12 caused by mutation in the ATP-binding cassette subfamily C member 8 (ABCC8) gene, supplemented by literature review.Results The patient was a 32-year-old female with a BMI of 22.06 kg/m². She was hospitalized due to pancreatitis, during which examinations revealed a fasting blood glucose level of 11.99 mmol/L, a random blood glucose level of 21.07 mmol/L, and a glycated hemoglobin (HbA1c) level of 9.3%. Her fasting insulin was 15.112 μU/mL, with a peak postprandial insulin level of 55.747 μU/mL. The fasting C-peptide was 0.49 ng/mL, and the peak postprandial C-peptide was 3.04 ng/mL. All diabetes-related autoantibodies were negative, leading to a suspicion of a special type of diabetes. Whole-exome sequencing of the patient's familial genomic DNA, verified by Sanger sequencing in relatives, revealed that both the patient and her father carried a heterozygous ABCC8 (NM_000352.6) c.824G>A (p. Arg275Gln) mutation. Multiple bioinformatics tools predicted this variant to be pathogenic. Initially treated with basal insulin combined with miglitol, the patient was switched to low-dose sulfonylurea (glimepiride 1 mg/day) after genetic confirmation, achieving optimal glycemic control during follow-up. Conclusion For young- or middle-aged-onset diabetes patients with negative autoantibodies, preserved pancreatic function, and no significant insulin resistance, MODY should be considered. For confirmed MODY12 cases with genetic testing, low-dose sulfonylurea therapy can achieve excellent glycemic control while avoiding unnecessary long-term insulin injections.

     

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