胰岛自身抗体联合生化指标检测在成人隐匿性糖尿病诊断中的临床意义

目的 通过对血清谷氨酸脱羧酶抗体(GAD)、胰岛细胞抗体(ICA)、血糖、糖化血红蛋白(HbAlc)的联合检测,探讨临床诊断为2型糖尿病(T2DM)患者中发现成人隐匿性自身免疫性糖尿病(LADA)的意义和诊断价值.方法 测定349例T2DM患者的血清GAD、ICA、C肽、血糖及HbAlc,检测出其中的LADA患者,并与T2DM患者的各项指标进行比较分析.结果 349例T2DM患者中共确诊为LADA患者27例(7.74％).LADA患者空腹C肽及餐后2hC肽分别为(0.31±0.21)、(0.90±0.22)μg/L,较T2DM患者的空腹C肽(1.23±0.85)μg/L和餐后2hC肽(3.45±2.96)μg/L明显降低,差异有统计学意义(P＜0.05).LADA患者空腹血糖及HbAlc分别为(12.15±25.01 )mmol/L、(10.12±2.78)％,较T2DM患者的(9.45±13.07)mmol/L、(8.04±2.95)％明显升高,差异有统计学意义(P＜0.05).结论 各项指标联合胰岛β细胞自身抗体检测可提高LADA患者的检出率,有助于LADA的早期诊断.

Clinical significance of combined detection of insulin autoantibody and biochemical indexes on diagnosis of latent diabetes in adults

Objective To perform the combined detection of serum glutamic acid decarboxylase antibody(GADA),islet cell antibody(ICA),blood glucose,glycosylated hemoglobin(HbA1c),and to discuss its significance and diagnostic value to find latent autoimmune diabetes in adults(LADA) patients with type 2 diabetes mellitus(T2DM).Methods The levels of serum GAD,ICA,proinsulin C-peptide,blood glucose and HbA1c in 349 cases of T2DM were measured for finding out the patints with LADA and compared with various indexes in the patients with T2DM..Results Among 349 cases of T2DM,27 cases were detected LADA(7.74%).The levels of fasting plasma C-peptide and 2 h postprandial C-peptide in the patients with LADA were(0.31±0.21)μg/L and(0.90±0.22) μg/L,which were lower than(1.23±0.85)μg/L and(3.45±2.96)μg/L in the patients with T2DM,showing statistical difference(P<0.05).The fasting glucose and HbA1c in the patients with LADA were(12.15±25.01)mmol/L and(10.12±2.78)% and significantly higher than(9.45±13.07)mmol/L and(8.04±2.95)% in the patients with T2DM with statistical difference between them(P<0.05).Conclusion The combined detection of insulin B cell autoantibody and biochemical indexes could increase the detection rate of LADA,which is beneficial to the early diagnosis of LADA.