目的 探讨不同体质指数（BMI）分组成年1型糖尿病（T1DM）患者的临床特征以及超重/肥胖与心血管代谢危险因素之间的关系。方法 纳入2015年6月至2022年6月在广州市第一人民医院内分泌代谢科住院的268例成人T1DM患者。分为超重肥胖组（BMI≥24.0 kg/m²，41例）、体质量正常组（18.5≤BMI＜24.0 kg/m²，155例）和体质量过低组（BMI＜18.5 kg/m²，72例）。比较三组人口学、人体测量及代谢指标的差异，采用多元线性回归分析BMI与估算肾小球滤过率（eGFR）的关联。结果 超重肥胖组患者的特征表现为年龄更大、病程更长、体脂肪量更高、腹部皮下脂肪面积更大、腰围、臀围更大、合并高血压比例更高、收缩压更高、高密度脂蛋白胆固醇更低、eGFR更低、糖化血红蛋白（HbA1c）更低。多元线性回归分析显示，校正年龄、性别、病程后，BMI与eGFR呈负相关（β=-2.050，P=0.012）；进一步校正HbA1c、血压、血脂后，该关联不再显著。结论 超重/肥胖成人T1DM患者存在多重代谢异常聚集，BMI与eGFR的负向关联可能主要与血糖、血压、血脂等代谢因素有关。

Objective To investigate the clinical characteristics of adult patients with type 1 diabetes mellitus（T1DM）in different body mass index（BMI）categories and the associations of overweight and obesity with cardiometabolic risk factors．Methods A total of 268 adult T1DM inpatients from Guangzhou First People’s Hospital were enrolled．Patients were divided into three groups：overweight/obese（BMI≥24.0 kg/m²，n=41），normal-weight（18.5≤BMI＜24.0 kg/m²，n=155），and underweight（BMI＜18.5 kg/m²，n=72）．Demographic characteristics，anthropometric measurements，and metabolic parameters were compared among the three groups．Multivariable linear regression analyses were performed to evaluate the association between BMI and estimated glomerular filtration rate（eGFR）．Results Patients in the overweight/obesity group were characterized by older age，longer diabetes duration，higher body fat mass，larger abdominal subcutaneous fat area，greater waist and hip circumferences，a higher prevalence of hypertension，higher systolic blood pressure，lower high-density lipoprotein cholesterol levels，lower eGFR，and lower glycated hemoglobin（HbA1c）levels．Multivariable linear regression analysis demonstrated that BMI was inversely associated with eGFR after adjustment for age，sex，and diabetes duration（β=-2.050，P=0.012）．However，this association was no longer significant after further adjustment for HbA1c，blood pressure，and lipid parameters．Conclusions Overweight/obese adult T1DM patients exhibit clustering of metabolic abnormalities．The negative association between BMI and eGFR may be primarily mediated by metabolic factors such as hyperglycemia，hypertension，and dyslipidemia．

       1型糖尿病（T1DM）是一种免疫介导的胰岛β细胞特异性破坏的自身免疫性疾病，全球发病率逐年上升。胰岛自身抗体（IAbs）是T1DM最可靠的生物标志物，用于早期预测和诊断。然而，传统的放射配体法（RBA）虽然具有高实验特异度，但在疾病特异度方面存在局限性，尤其是单抗体阳性的预测价值较低。近年来，电化学发光法（ECL）作为一种无放射性污染的新方法，能够区分高亲和力和低亲和力的IAbs，显著提高了疾病特异度。多项研究表明，ECL法在预测T1DM风险方面优于RBA法，特别是在单抗体阳性的情况下。本文综述了IAbs检测方法的进展及其在T1DM预测和诊断中的应用，强调了ECL法在提高疾病特异度方面的优势。

       Type 1 diabetes mellitus（T1DM）is  an  autoimmune  disease  characterized  by the immune-mediated destruction of pancreatic β-cells，with a rising global incidence．Islet autoantibodies（IAbs）are the most  reliable biomarkers for early prediction and diagnosis of T1DM．However，the traditional radio-binding assay（RBA），despite its high experimental specificity，has limitations in disease specificity，particularly in the predictive value of single autoantibody positivity．Recently，the electrochemiluminescence（ECL）method，a non-radioactive approach，has been developed to distinguish high-affinity from low-affinity IAbs，significantly improving disease specificity．Multiple studies have shown that the ECL method outperforms RBA in predicting T1DM risk，especially in cases of single autoantibody positivity．This review discusses the advancements in IAbs detection methods and their applications in T1DM prediction and diagnosis，highlighting the advantages of the ECL method in enhancing disease specificity．