糖尿病患者3种自身抗体联合检测的临床意义

目的探讨谷氨酸脱羧酶抗体(GAD-Ab)、胰岛细胞抗体(ICA)和胰岛素自身抗体(IAA)检测在糖尿病(DM)中的临床意义。方法应用酶联免疫吸附法和放射免疫法对50例1型糖尿病(T1DM)患者、76例2型糖尿病(T2DM)患者和50例健康者(对照组)进行血清GAD-Ab、ICA、IAA检测。结果 T1DM组GAD-Ab、ICA、IAA阳性率分别为70.0%、38.0%和22.0%,三者联合检测阳性率为84.0%,均高于T2DM组(P<0.05);T2DM组GAD-Ab、ICA、IAA阳性率分别为10.5%、17.1%和10.5%,三者联合检测阳性率为32.9%,均高于对照组(P<0.05)。结论血清GAD-Ab、ICA、IAA检测对DM分型、指导临床用药及判断预后具有重要的临床应用价值。     

成人迟发自身免疫性糖尿病临床特征分析

目的：探讨成人迟发自身免疫性糖尿病(LADA)的临床特征。方法：比较谷氨酸脱羧酶(GADA)及胰岛细胞抗体(ICA)阳性的LADA患者与2型糖尿病患者的急慢性并发症的患病率。结果：LADA患者的年龄、体重指数、空腹及餐后C肽水平均低于2型糖尿病，而酮症发生率高；视网膜病变、肾脏病变、高血压发生率低于2型糖尿病，而冠心病、脑梗塞两者无差异。结论：LADA的临床特征与2型糖尿病有所不同。     

糖尿病自身抗体在不同年龄组段糖尿病患者的阳性率分析

目的 探讨糖尿病自身抗体在不同年龄组段糖尿病患者的阳性率。方法采用ELISA法检测三个年龄组（5-25岁52例、26-49岁135例及50-80岁250例）共437例糖尿病患者ICA、IAA及GAD抗体。结果IAA阳性率5-25岁组明显高于26-49岁组和50-80岁组．差异有非常显著性（P〈0．01）；ICA和IAA＋ICA阳性率在5-25岁组明显高于26-49岁组和50-80岁组（P〈0．01），26-49岁组和50-80岁组阳性率无明显差异（P〉0．05）：GAD和ICA＋GAD阳性率在26-49岁组和50-80岁组明显高于5-25岁组（P〈0．01），26-49岁组和50-89岁组阳性率无明显差异（P〉0．05）。结论青少年糖尿病患者（5-25岁）ICA、IAA抗体阳性率较高，较高年龄组糖尿病患者（〉25岁）GAD抗体阳性率较高。     

1202例糖尿病患者检测自身抗体与年龄相关的分析

目的探讨糖尿病自身抗体与年龄的相关性。方法采用ELISA方法检测1202例糖尿病患者GADI、CAI、AA抗体。结果1202例受检患者中,GAD刚性309例,刚性率25.71%,ICA刚性316例,刚性率26.29%,IAA阳性118例,刚性率9.82%,不同年龄组段的GAD刚性率卡方趋势结果P<0.05,ICAI、AA阳性率卡方趋势结果均P>0.05。     

自身抗体筛检隐匿型自身免疫性糖尿病的意义

目的:检测胰岛素自身抗体(IAA)、胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体(GADA)和血清C肽,筛选出成年隐匿型自身免疫性糖尿病(LADA)对其进行早诊断、早治疗。方法:采用ELISA法检测188例初诊糖尿病患者血清IAA、ICA和GADA,化学发光法检测空腹和餐后C肽。结果:阳性组50例患者中,GADA阳性率(16.0%)高于ICA阳性率(12.2%)和IAA阳性率(7.4%)。双抗体阳性率为6.9%,三抗体阳性率为1.1%。抗体阳性患者的空腹和餐后C肽明显低于抗体阴性患者,双抗体和三抗体阳性患者的空腹和餐后C肽低于单抗体阳性患者。结论:自身抗体阳性患者的胰岛功能明显低于阴性患者。双抗体或三抗体的阳性患者,其胰岛功能丧失的更多。通过三抗体联合检测在初诊糖尿病患者中筛选LADA,对其早诊断早治疗具重要意义。     

儿童糖尿病患者自身抗体联合检测的意义

目前对1型糖尿病的免疫标志研究较多,但对特异性、敏感性的评价尚不一致。本研究对87例1型糖尿病儿童和106例健康儿童进行了3种自身抗体的检测,旨在评价各种抗体联合检测的临床应用价值。     

糖尿病谷氨酸脱羧酶抗体、胰岛细胞抗体的检测(附206例报告)

目的探讨谷氨酸脱羧酶抗体(GAD)、胰岛细胞抗体(ICA)的检测价值。方法检测糖尿病患者血GAD、ICA、C肽,将患者分为3组A组(1型糖尿病患者组)、B组(<40岁、体形不胖的2型糖尿病患者组)、C组(除B组以外的其他2型糖尿病患者组),比较3组的检测结果。结果A组GAD、ICA、GAD ICA的阳性率明显高于B、C组,C肽值明显低于B、C组,并且GAD和(或)ICA阳性者的C肽值明显低于阴性者。结论GAD、ICA对鉴别1型、2型糖尿病、诊断迟发型自身免疫性糖尿病(LADA)有价值。     

糖尿病自身抗体阳性患者治疗后其自身抗体随时间的变化

目的探讨糖尿病自身抗体阳性患者其自身抗体治疗后随时间的变化。方法采用ELISA方法分别检测87例治疗前(第一次)和治疗半年后至一年内(第二次)及其中23例治疗一年后至两年内(第三次)糖尿病患者GADI、CAI、AA抗体。结果受检患者中,第一次和第二次、第三次GAD阳性率分别为69.0%、52.9%、47.8%,三次GAD阳性率卡方检验(P<0.05)有统计学意义;ICA阳性率分别为63.2%、47.1%、39.1%,三次ICA阳性率卡方检验(P<0.05)有统计学意义;IAA阳性率分别为24.1%、11.5%、8.7%,三次IAA阳性率卡方检验(P<0.05)有统计学意义。结论糖尿病患者GADI、CAI、AA阳性率在治疗后随时间逐渐降低。     

糖尿病自身抗体联合检测在糖尿病分型中的应用价值研究

目的探讨糖尿病自身抗体联合检测在糖尿病分型中的应用价值,为正确分型糖尿病提供理论依据。方法选择我院内分泌科收治的126例糖尿病患者,其中1型糖尿病组51例,2型糖尿病组75例,同时选择健康对照组60例,采用免疫印迹试剂法检测胰岛细胞抗体（ICA）、胰岛素自身抗体（IAA）和谷氨酸脱羧酶抗体（GADA）表达情况,计算阳性率,并对结果进行比较分析。结果 ICA、IAA和GADA在1型糖尿病患者中的阳性率分别为35.3%、31.4%和60.8%,显著高于2型糖尿病患者的1.3%、1.3%、2.7%及对照组的1.3%、0.0%、0.0%,均有显著性差异（P〈0.05）。ICA/IAA/GADA、GADA/ICA、GADA/IAA三种联合检测组合对1型糖尿病诊断的敏感性分别为92.2%、84.3%和82.4%,均显著高于单一抗体检测,均有显著性差异（P〈0.05）。结论检测血清ICA、IAA和GADA能够为正确鉴别1型糖尿病和2型糖尿病提供重要依据,联合检测能够提高诊断阳性率,避免漏诊,值得临床推广和普及。     

3种自身抗体联合生化指标检测在2型糖尿病患者的临床意义

目的探讨2型糖尿病患者中血清谷氨酸脱羧酶抗体(GADA)、抗胰岛素抗体(IAA)、抗胰岛细胞抗体(ICA)和生化指标检测的临床意义及成人隐匿性自身免疫性糖尿病(LADA)比例。方法对107例2型糖尿病患者和50例健康对照者进行3种自身抗体、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、糖化清蛋白(GA)、空腹胰岛素(INS)、空腹C肽进行检测,结合临床诊断出其中的LADA患者,对上述检测指标进行比较分析。结果 GADA、IAA、ICA在2型糖尿病患者检测的阳性率分别为15.88%、17.75%、3.73%;联合检测阳性率为28.03%,高于健康对照组和单一抗体患者。自身抗体阳性组和阴性组比较,HbA1c、GA、空腹C肽水平比较,差异有统计学意义(P0.05)。107例2型糖尿病患者中确诊11例LADA患者,LADA患者HbA1c、GA水平高于非LADA 2型糖尿病患者,C肽水平低于非LADA 2型糖尿病患者,差异均有统计学意义(P0.05)。结论在2型糖尿病患者中检测胰岛自身抗体对检出其中的LADA有重要指导价值,联合生化指标连续监测有利于对疾病鉴别诊断,从而尽快采取措施保护胰岛β细胞功能,减少进一步损伤。     

GAD65 autoantibody responses in Japanese latent autoimmune diabetes in adult patients

OBJECTIVE—To determine whether development of insulin requirement in patients with latent autoimmune diabetes in adults (LADA) is accompanied with the emergence of a type 1 diabetes–like autoimmune response.RESEARCH DESIGN AND METHODS—We correlated β-cell–specific autoimmunity reflected in autoantibodies to the 65-kDa isoform of GAD (GAD65) with insulin requirement. We determined GAD65Ab epitope specificities in type 1 diabetic patients, LADA patients without insulin requirement (nonprogressed), and LADA patients that had developed insulin requirement (progressed).RESULTS—Recognition of a type 1 diabetes–specific GAD65Ab epitope was more pronounced in type 1 diabetic patients than in nonprogressed (P < 0.001) or progressed (P < 0.01) LADA patients, with no significant differences between the two LADA cohorts. These differences were particularly pronounced in samples with GAD65Ab titers <1,000 units/ml, with no differences in epitope specificities in samples with higher GAD65Ab titers. Disease duration (initial diabetes diagnosis until sample collection or development of insulin requirement) in nonprogressed and progressed LADA patients, respectively, was not correlated with epitope specificity, suggesting lack of epitope maturation. This was supported by epitope analyses of longitudinal samples from LADA patients during progression to insulin requirement.CONCLUSIONS—First, the GAD65Ab-specific autoimmune reaction in type 1 diabetic patients with low and moderate GAD65Ab titers differs from that in LADA patients, irrespective of insulin requirement. Second, the GAD65Ab-specific autoimmune response in LADA patients does not change after their initial diabetes diagnosis. Finally, LADA patients with high GAD65Ab titers resemble type 1 diabetic patients in their GAD65Ab epitope specificity.Latent autoimmune diabetes in adults (LADA) consists of a subgroup (∼10%) of adult patients initially diagnosed with type 2 diabetes, who show signs of β-cell autoimmunity and eventually develop insulin requirement (1,2). Signs of β-cell autoimmunity, such as the well-characterized insulin autoantibodies, glutamate decarboxylase (GAD65), and the tyrosine phosphatase–like protein insulinoma-associated protein-2, indicate significant damage of the β-cells and subsequent development of insulin requirement in these patients (1). While autoantibodies to insulin and insulinoma-associated protein-2 antibody (Ab) are inversely correlated with age at onset, GAD65Ab shows no, and in some studies even a positive, correlation with age at onset and is therefore a particularly attractive marker for autoimmune diabetes in the adult population (3,4). Moreover, GAD65Ab can be detected years after the clinical onset of the disease, indicating that these autoantibodies may be permanent markers for the autoimmune response (5,6).Notably, not all LADA patients progress to insulin requirement, raising the possibility that the autoimmune response in these patients resembles that in autoantibody-positive healthy individuals, with no significant risk for development of insulin requirement (7,8). A better understanding of the autoimmune response is necessary to predict insulin requirement in LADA patients, which is important to prevent escalation of blood glucose levels and subsequent complications.In previous studies, we have investigated the humoral immune response toward GAD65 as a reflection of islet cell destruction (9). It remains unclear whether the autoimmune response in LADA patients and type 1 diabetic patients differs or whether only the duration of the prodomal period distinguishes between the two groups (10). Therefore, we compared the GAD65-specific humoral autoimmune response in type 1 diabetic patients with that in LADA patients who had or had not progressed to insulin requirement.     

3种梅毒诊断试验的临床应用评价

目的 通过比较3种检测方法的敏感性和特异性,选择简单、快速、高敏感性和特异性诊断方法和试剂诊断早期梅毒,及早发现传染源,控制梅毒传播.方法 采用甲苯胺红不加热血清反应素试验(TRUST),梅毒螺旋体特异性抗体酶联免疫吸附试验(TP-ELISA),梅毒螺旋体特异性抗体明胶凝集试验(TPPA)3种方法对梅毒患者血清进行检测.结果 TRUST法敏感度为90%,特异性为96.7%;TP-ELISA法敏感度为98.3%,特异性为100%;TPPA法敏感度为98.3%,特异性为100%.结论 对梅毒患者同时采用TRUST和ELISA(或TPPA)法进行血清学联合检测,可提高阳性检出率和判断疗效.     

低危人群中梅毒螺旋体抗体3种血清学检测方法应用研究

目的探讨3种梅毒螺旋体血清学试验用于梅毒螺旋体感染的初筛和确认的必要性。方法对34933例标本采用酶联免疫吸附试验（EusA）进行梅毒螺旋体的初筛,初筛结果为可疑阳性的样本进行梅毒螺旋体明胶凝集试验（TPPA）和甲苯胺红不加热血清反应素试验（TRUST）的检测。结果559例标本初筛结果为可疑阳性,其中,TPPA阳性423例,TRUST阳性210例。结论3种检验方法的结果各有其价值,将3种方法的结果均报告给临床医生有助于临床医生的综合诊断,减少医患纠纷。     

Evaluation of three potential screening tests for diabetes mellitus in a biethnic population

We tested the ability of three potential screening tests for diabetes (fasting plasma glucose value greater than or equal to 140 mg/dl, 1-h postglucose (PG) load value greater than or equal to 200 mg/dl, and 2-h PG value greater than or equal to 200 mg/dl) to detect non-insulin-dependent diabetes in 130 diabetic Mexican Americans (MAs) and 50 diabetic Anglo Americans (AA) using the National Diabetes Data Group criteria as the standard. The sensitivity of the fasting plasma glucose (FPG) cutpoint in detecting diabetes was low in both AAs (36.0%) and MAs (59.3%) and was related to the age-adjusted prevalence rates of diabetes in the two ethnic groups (AAs, 4.9%; MAs, 10.9%). The 2-h PG load cutpoint had good sensitivity (greater than 93%) and specificity (greater than 99%) in both ethnic groups. The ethnic difference in the sensitivity of the FPG cutpoint appeared to be related to the greater hyperglycemia of diabetic MAs compared with diabetic AAs. Nearly 30% of diabetic MAs had FPG values greater than or equal to 200 mg/dl as contrasted with only 10% of diabetic AAs. The difference in severity of hyperglycemia between the ethnic groups appears to be unrelated to ethnic differences in adiposity, pharmacologic treatment, or delay in diagnosis, although longer disease duration in MAs may explain part of the difference.     

Efficient cutoff points for three screening tests for detecting undiagnosed diabetes and pre-diabetes: an economic analysis

OBJECTIVE: Opportunistic screening for undiagnosed type 2 diabetes and pre-diabetes (either impaired glucose tolerance or impaired fasting glucose) is recommended by the American Diabetes Association. The aim of this study was to determine efficient cutoff points for three screening tests for detecting undiagnosed diabetes alone or both undiagnosed diabetes and pre-diabetes. RESEARCH DESIGN AND METHODS: We estimated the number of individuals with undiagnosed diabetes alone or with both undiagnosed diabetes and pre-diabetes that could be detected by using different cutoff points for each screening test as the product of the prevalence of each condition, the sensitivity of the tests at each cutoff point for identifying each condition, and the number of individuals who would be eligible for screening in the U.S. We estimated the total cost of opportunistic screening by multiplying the cost for screening one person by the number of individuals screened. RESULTS: The most efficient cutoff points for both detecting pre-diabetes and undiagnosed diabetes (100 mg/dl for the fasting plasma glucose test, 5.0% for the HbA(1c) test, and 100 mg/dl for the random capillary blood glucose test) were less than those for detecting undiagnosed diabetes alone (110 mg/dl for the fasting plasma glucose test, 5.7% for the HbA(1c) test, and 120 mg/dl for the random capillary blood glucose test). CONCLUSIONS: A lower cutoff value should be used when screening for pre-diabetes and undiagnosed diabetes together than when screening for undiagnosed diabetes alone.     

糖尿病患者甲状腺自身抗体、血清中硒水平研究及临床意义分析

目的 探讨不同型别糖尿病患者甲状腺自身抗体及血清中硒水平的变化及其相关影响因素。 方法 选取糖尿病患者50例(2型糖尿病患者30例和1型糖尿病患者20例)为实验组,健康体检者50例为对照组,采用化学发光法分别测定三组的抗甲状腺过氧化酶抗体(TPOAb)和抗甲状腺球蛋白抗体(TGAb)水平,采用竞争性的酶联免疫分析法检测促甲状腺激素受体抗体(TRAb)水平。采用原子吸收光谱法测定各组血清硒的水平,观察各组间的差异及血清硒与甲状腺自身抗体的相关性,并进行统计学分析。 结果 糖尿病组的TPOAb、TRAb、TGAb水平显著高于健康体检组(t=3.246、4.017、3.267,P0.05),血清硒水平则显著低于健康体检组(t=-6.794,P0.05)。而2型糖尿病TGAb和血清硒水平显著高于1型糖尿病患者(t=2.143、3.012,P0.05)。在2型糖尿病患者中,血清硒水平与TRAb呈负线性相关(r=-0.767,P0.05)。 结论 糖尿病患者甲状腺自身抗体及血清硒水平均已发生改变,2型糖尿病患者TRAb水平与血清硒水平高度负线性相关。     

Simultaneous triple organ specific autoantibody profiling in adult patients with type 1 diabetes mellitus and their first-degree relatives

AIMS: We aimed to document prevalence and clinical presentations of seropositivities for glutamate decarboxylase (GAD)-antibody, celiac's disease (CD) and autoimmune thyroiditis (AIT) in adult patients with type 1 diabetes mellitus (T1DM), and their first-degree relatives. METHODS: Sixty-five patients with T1DM, 124 first-degree relatives and 65 healthy controls were screened for GAD-antibody, anti-thyroid peroxidase (ATPO), anti-thyroid stimulating hormone receptor (TSHR), anti-tissue transglutaminase and anti-gliadin antibodies in a matched case-control study. RESULTS: Prevalence of more than one seropositivity for CD-associated antibodies in T1DM-group is 6.0 times increased, compared with controls (p < 0.05). ATPO seropositivity is 5.3 times increased in T1DM group (p < 0.05), but TSHR antibody is comparable with controls (p > 0.05). Seropositivities for T1DM, AIT and CD are 4.3, 1.9 and 2.4 times more prevalent among first-degree relatives respectively, compared with controls (p < 0.05). Pathologically confirmed cases with CD among first-degree relatives were all identified at screening. In contrast, all of pathologically confirmed cases with CD in T1DM group, were either previously diagnosed or symptomatic at time of screening. In the group of patients with T1DM, 31% of seropositive cases for anti-ATPO were clinically latent for AIT, and 74% of ATPO (+) cases were identified at current screening study. Sixty-four per cent of ATPO (+) first-degree relatives were clinically latent for AIT, and 54% were identified at screening. CONCLUSION: Type 1 diabetes mellitus, CD and AIT represent a significant overlap in an adult population with already-diagnosed T1DM and their first-degree relatives. With regard to clinical presentations, CD was less likely to be clinically silent than AIT among patients with T1DM.     

3项试验对类风湿关节炎临床诊断价值的探讨

目的探索血液中高敏c反应蛋白（Hs—CRP）、类风湿因子（RF）和红细胞沉降率（ESR）对类风湿关节炎的临床诊断价值。方法41例类风湿关节炎和45例健康对照组的Hs-CRP和RF用胶乳增强免疫比浊法测定,ESR用枸橼酸钠经抗凝血用魏法测定。结果类风湿关节炎患者的Hs—CRP测定结果比健康对照组高10倍以上,其均值与健康对照组比较P〈0．01,差异有统计学意义;Hs—CRP的阳性率为97．6％,RF阳性率为68．3％,ERS的阳性率为46．3％。结论Hs—CRP测定优于RF和ESR对类风湿性关节炎临床诊断。     

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.     

组织细胞肉瘤3例临床病理学分析

组织细胞肉瘤(histiocytic sarcoma,HS)是一种瘤细胞具有成熟组织细胞形态与免疫表型特征的恶性肿瘤,不包括急性单核细胞白血病相关的肿瘤性增生[1].此类肿瘤罕见,诊断与鉴别诊断亦很困难.本文总结了3例HS患者的临床病理学特点,并复习国内外文献资料,以提高对HS的病理特征、免疫表型、鉴别诊断和预后的认识...