T2DM 患者糖尿病自身抗体检测及其临床价值

目的：探讨检测糖尿病自身抗体对从2型糖尿病(type 2 diabetes mellitus,T2DM)患者中筛查出成人晚发自身免疫性糖尿病(latent autoimmune diabetes in adult,LADA)的价值。方法采用酶联免疫法对73例T2DM 患者及30例健康体检者血清谷氨酸脱羧酶抗体(glutamic acid decarboxylase antibody,GADA)、胰岛细胞抗体(islet cell antibody,ICA)、胰岛素自身抗体(insulin autoantibody,IAA)、蛋白酪氨酸磷酸酶抗体(protein tyrosine phosphatase-like IA-2 autoantibody,IA-2A)进行检测；分析抗体构成并比较抗体阴性与阳性患者之间的临床差异。结果与对照组比较,T2DM 组 GADA(19.2%)和 IAA(12.3%)两种自身抗体阳性率明显增高,其差异有统计学意义(P <0.05)。单项抗体检测以 GADA 的阳性率最高(19.2%),两项抗体联合检测以 GADA+IAA 和 GADA+ICA 阳性率较高(28.8%和27.4%)；3项抗体联合检测以 GADA+ICA+IAA 阳性率最高(38.4%)；4项抗体同时检测阳性率可达39.7%。自身抗体阳性组体质量指数、空腹及餐后120 min C 肽值均低于自身抗体阴性组(P <0.05),年龄、性别构成比、空腹及餐后120 min 血糖和病程的差异无统计学意义(P >0.05)。结论糖尿病自身抗体的检测对1型糖尿病(type 1 diabetes mellitus,T1DM)的诊断及 LADA 的筛查具重要临床意义。

Measurement of Autoantibodies and its Clinical Value in Patients with Type 2 Diabetes Mellitus

Objective To explore the value of measurement of autoantibodies in patients with type 2 diabetes mellitus (T2DM)on screening latent autoimmune diabetes in adult (LADA).Methods Enzyme-linked immune sorbent assay(ELISA)was used to detect the glutamic acid decarboxylase antibodies (GADA),islet cell antibodies (ICA),insulin autoantibodies (IAA),and protein tyrosine phosphatase-like IA-2 autoantibody (IA-2A)in 73 patients with T2DM and 30 healthy people;the constitution of antibodies and clinical differences between antibody-negative and antibody-positive patients were analyzed.Results Compared with control group,the positive rate of GADA (1 9.2%)and IAA (12.3%)in patients with T2DM was obviously higher,the differences of which were statistically significant (P < 0.05 ).The positive rate of GADA was highest (1 9.2%)in the single antibody detection;the positive rate of GADA + IAA and GADA + ICA were highest in joint detection of two antibodies combined (28.8%,27.4%);the positive rate of GADA + ICA + IAA was highest in detection of three antibodies (38.4 %);the positive rate reached 39.7% in detection of four antibodies simultaneously.The body mass indexes (BMI,fasting and postprandial 120min C-peptide values)of autoantibody-positive group were lower than those in autoantibody-negative group (P <0.05),and differences among indexes of different age,gender ratio,fasting and postprandial blood glucose 120 min and duration were not statistically significant (P >0.05).Conclusion Detection of autoantibodies has clinical significance in the diagnosis of type 1 diabetes (T1DM)and screening out LADA.