血清胰岛自身抗体在肝源性糖尿病诊断中的价值

目的探讨血清胰岛自身抗体一谷氨酸脱羧酶抗体（GADA）和胰岛细胞抗体（ICA）在肝源性糖尿病诊断中的价值。方法采用酶联免疫吸附实验测定217例慢性乙型肝炎（CH）、肝硬化（LC）患者血清GADA和ICA，观察GADA、ICA在CH、LC阶段的阳性率及其与糖尿病的关系。结果CH、LC合并糖尿病的患者72％（56／77）循环中存在一种胰岛自身抗体，而血糖正常的CH、LC患者胰岛自身抗体的阳性率为30％（42／140），两组比较差异有显著性（χ2=-36．620，P=0．000）。CH合并糖尿病患者胰岛自身抗体阳性率52％（13／25）明显高于2型糖尿病（NIDDM）合并肝损害的患者8％（2／25）（P〈0．05）。C肽水平下降的CH、LC患者中胰岛自身抗体阳性率70%（24／34）亦明显高与C肽水平正常的患者40%（74／183）（P〈0．05）。结论GADA、ICA在肝源性糖尿病的诊断中有重要参考价值，可作为肝源性糖尿病和2型糖尿病的实验室鉴别诊断指标。

Diagnostic value of serum islet autoantibody in hepatogenic diabetes mellitus

OBJECTIVE: To investigate the diagnostic value of serum islet autoantibody-glutamic acid decarboxylase antibody (GADA) and islet cell antibody (ICA) in patients with hepatogenic diabetes. METHODS: Serum GADA and ICA were measured with enzyme-linked immunosorbent assay (ELISA) in 217 patients with chronic hepatitis B (CH) or liver cirrhosis (LC). The positivity rate of GADA and ICA in different phases of CH and LC and their relations with diabetes mellitus were analyzed. RESULTS: The positivity rate of the islet autoantibody in the circulation was 72% in CH and LC patients with diabetes mellitus and 30% in patients with normal glucose level, showing significant difference between the two patient groups (Chi2=36.620, P=0.000). CH patients with diabetes had much higher positivity rate for the antibody [52% than type 2 diabetic patients with liver dysfunction [8%, P<0.05]. The positivity rate was also much higher in CH and LC patients with lowered C peptide level [70%] than in those with normal C peptide level [40%, P<0.005]. CONCLUSION: Both GADA and ICA have important value in the diagnosis of hepatogenic diabetes and may serve as indexed in laboratory test for distinguishing hepatogenic diabetes from type 2 diabetes.