不同胰岛自身抗体阳性1型糖尿病临床特征分析

目的探讨单独或合并锌转运体8自身抗体(ZnT8A)、谷氨酸脱羧酶抗体(GADA)及蛋白酪氨酸磷酸酶抗体(IA-2A)阳性患者的1型糖尿病(T1DM)患者临床特征。方法采用放射配体检测法检测中南大学湘雅二医院1999—2009年收治的539例T1DM患者的ZnT8A、GADA及IA-2A,并将其分成三个亚组进行比较。结果(1)单一ZnT8A阳性组较抗体阴性组病程更长,胰岛素用量更大,收缩压更低,合并代谢综合征比例更少。单一ZnT8A阳性组较单一GADA阳性组BMI、WHR及空腹C肽值更高(P<0.05),而糖化血红蛋白水平更低(P<0.05);(2)多个抗体阳性组起病年龄显著低于抗体阴性组(P<0.05);1个抗体阳性患者的空腹C肽及餐后2 h C肽显著低于抗体阴性组(P<0.05);3个抗体阳性患者较1个抗体阳性患者的起病年龄更小(P<0.01),BMI更低(P<0.05),病程更短(P<0.05)。(3)合并任意两种抗体阳性中"GADA阳性与IA-2A阳性"组餐后C肽最低(P<0.01),空腹C肽也较低,但差异无统计学意义(P>0.05)。结论单独或合并ZnT8A,GADA及IA-2A的T1DM临床特征分析对临床具有重要的指导意义。

Analysis of clinical features of type 1 diabetes patients with positive autoantibodies from different pancreatic island

Objective To analyze the clinical features of of type 1 diabetes(T1DM) patients with single or conbination of positive ZnT8A,GADA and IA-2A.Methods ZnT8A,GADA and IA-2A were detected by radioligand binding assay and divided into three subgroups.The outcomes were then compared.Results(1)Single ZnT8A+ group had a longer disease progession,larger use for insulin,lower systolic pressure and lower proportion of metabolic syndrome than negative antibody group.The BMI,WHR and fasting C peptide in single ZnT8A+ group were higher than those in single GADA+ group,while the glycolated hemoglobin level was much lower(P<0.05).(2)The multiple antibodies-positive group had a significantly lower occurrence age than antibody-negative group(P<0.05).One patient with positive antibody had obviously lower fasting C peptide and C peptide at 2 h after dinner as compared with antibody-negative group.Furthermore,three antibody-positive patients had a lower occurrence age(P<0.01),lower BMI(P<0.05) and shorter disease progression(P<0.05) than one antibody-positive patient.(3)In combination of two arbitrary antibodies,GADA+ and IA-2A+ group had the lowest postprandial C peptide and the relatively lower fasting C peptide,but no significant difference was found(P>0.05).Conclusion The analysis on clinical characteristics of T1DM patients with single or combination of ZnT8A,GADA and IA-2A may be of great guiding significance in clinic.