蛋白酪氨酸磷酸酶抗体对成人隐匿性自身免疫性糖尿病的诊断价值

目的探讨蛋白酪氨酸磷酸酶抗体（IA-2A）对成人隐匿性自身免疫性糖尿病（LADA）的诊断价值。方法采用放射配体法检测2027例初诊2型糖尿病（T2DM）患者的IA．2A和谷氨酸脱羧酶抗体（GAD-Ab），分析IA-2A在初诊T2DM患者中的分布及其与临床特征的关系。结果初诊T2DM患者中IA-2A阳性检出率低于GAD-Ab阳性检出率（2．2％7）S10．6％，P〈0．01）。联合GAD-Ab和IA-2A检测，可使LADA阳性检出率达11．5％。IAm2A在低体重、低c肽水平患者中阳性检出率高；随着起病年龄增大，IA-2A阳性检出率下降（P〈0．05）。与T2DM组比较，单独IA-2A阳性患者使用胰岛素治疗的比例高（P〈0．05）。高滴度IA-2A阳性LADA患者具有起病年龄小（P〈0．01）、体重轻、高血压比例低、空腹C肽低、合并GAD-Ab阳性和使用胰岛素比例高（P〈0．05）等特点。结论IA-2A检测对LA—DA具有辅助诊断价值，与GAnAb联合检测可提高LADA诊断的敏感性。

The diagnostic value of protein tyrosine phosphatase antibody for latent autoimmune diabetes in adults

Objective To explore the diagnostic value of protein tyrosine phosphatase antibody （IA- 2A） for latent autoimmune diabetes in adults （LADA）. Methods Radioligand assay was used to test IA- 2A and glutamic aeid decarboxylase antibody（GAD-Ab）in 2 027 patients with newly diagnosed phenotypie type 2 diabetes mellitus （T2DM）. The relationship of IA-2A with clinical features was analyzed. Results The positive rate of IA-2A was lower than that of GAD-Ab in the patients with newly diagnosed T2DM （2.2% vs 10. 6%, P〈0. 01）. Combined measurement of GAD-Ab and IA-2A could achieve the detection rate of LADA to 11.5%. The detection rate of IA-2A was higher in the group with low body weight and low C-peptide and declined with the increasing of age at onset （P〈0. 05）. Compared with T2DM patients, isolated IA-2A positive patients were more prone to insulin therapy （P〈0. 05）. The characteristics of LADA patients with high-titer positive IA-2A were as follows., younger age at onset （P〈0.01）, lower body mass index, lower fasting C-peptide, lower proportion of hypertension, and higher ratio of positive GAD-Ab and insulin therapy （P〈0.05）. Conclusions IA-2A testing is useful for identifying LADA from T2DM. Joint detection of GAD-Ab and IA-2A can improve the diagnostic sensitivity for LADA.