胰岛自身抗体联合测定与1型糖尿病相关性研究

目的:探讨胰岛自身抗体联合测定对早期诊断1型糖尿病的相关互补性及临床意义。方法:对686例糖尿病患者采用ELISA法定性检测ICA、IAA及定量检测GAD,用放射免疫法空腹和餐后2h检测C肽。结果:自身抗体双阳性者(ICA+GAD、GAD+IAA、ICA+IAA)68例,为受检人数的9.94％;单一ICA阳性者28例(4.08％),GAD阳性者24例(3.5％),IAA阳性者14例(1.98％),自身抗体双阳性检出率明显高于单一抗体阳性,有显著差异(P<0.01)。自身抗体双阳性组年龄为36.2±18.4岁,明显低于胰岛自身抗体阴性组(54.6±17.2岁),两组年龄有显著差异(P<0.01)。IAA+ICA阳性组平均年龄为32.6±18.4岁,低于ICA+GAD阳性组(40.4±19.6)和GAD+IAA阳性组(38.8±18.6),(P<0.001)。自身抗体双阳性组及单一GAD阳性组、ICA阳性组空腹和餐后2hC肽明显低于抗体阴性组(P<0.001)。单一IAA阳性组与抗体阴性组无明显差异(P>0.05)。结论:胰岛自身抗体阳性糖尿病患者胰岛细胞功能明显低于阴性患者,提示自身抗体阳性患者(单一IAA阳性除外)胰岛功能有明显损伤;单一IAA阳性患者不能反映胰岛功能受损程度。成年糖尿病患者GAD阳性率较高,青少年糖尿病患者ICA、IAA阳性率较高,三种抗体联合检测可提高对1型糖尿病患者诊断的敏感性和特异性,对1型糖尿病患者的早期诊断和治疗有重?

Correlation Between Combined Determination of Autoantibodies of Pancreas Islet and Type 1 Diabetes

Objective:To evaluate the complementation and clinical significance of combined determination of pancreas islet au-toantibodies for early diagnosis of type 1 diabetes. Methods: ICA, IAA and GAD were determined with ELISA and C-peptide with ra-dioimmunoassay in 686 diabetics.Results:The positive rate of double autoantibodies(ICA + GAD,GAD + IAA and ICA + IAA) was remarkably higher than that of single antibodies (IC A, GAD and IAA)(P < 0.01) .The average age in group with double positive au-toantibodies was lower than that in group with negative autoantibodies. The average age in group with IAA + ICA was lower than that in group with ICA + GAD and group with GAD + IAA( P < 0.001) . Fasting and postprandial C-peptide levels in group with double an-toantibodies and group with GAD or ICA was Lower than that in group with negative antibodies( P < 0.001) .There was not remarkable variation between group with IAA and group with negative antibody (P > 0.05) . Conclusion:The islet cell function of diabetics with positive autoantibodies is considerably lower than that of diabetics with negative autoantibodies. It indicates that the islet function of the former is damaged except group with IAA. Single IAA can not reflect the damaged level of islet cells. The positive rate of GAD arid ICA is higher in adult diabetics, and the positive rate of ICA and IAA is higher in juvenile diabetics. Combined determination of ICA, GAD and IAA may improve the sensitivity and specific for the diagnosis of type 1 diabetes and shows an important significance in early diagnosis and treatment of the disease.