1型糖尿病患者的临床特点和多种胰岛自身抗体检出情况

目的分析1型糖尿病（T1DM）患者多种胰岛自身抗体的检出情况和不同类型T1DM的临床特征。方法选取2010年11月至2011年11月在中日友好医院住院的67例T1DM患者，分析其临床特征及胰岛细胞抗体（ICA）、胰岛素抗体（IAA）、谷氨酸脱羧酶抗体（GADA）酶联免疫吸附试验（ELISA）法和免疫沉淀法（RIP）检测]、蛋白酪氨酸磷酸酶抗体（IA2A）和锌转运蛋白8抗体（ZnT8A）等6种胰岛自身抗体情况。结果本组T1DM共67例，其中经典型T1DM53例，成人迟发性自身免疫糖尿病（LADA）12例和暴发性1型糖尿病（FT1D）2例。起病年龄2～77岁，体质指数（BMI）（22±4）kg／m2，糖化血红蛋白（HbAlc）9．7％±2．4％，空腹C肽（0．3±O．4）μ／L。GADA（ELISA）阳性51例（76．1％），GADA（RIP）阳性35例（52．2％），IA2A阳性19例（28．3％），ZnT8A阳性16例（23．9％），IAA阳性16例（23．9％），ICA阳性10例（14．3％）。前4种抗体检测方法至少1种阳性者共56例（83．6％）。51例ELISA法GADA阳性包括了35例RIP检测GADA阳性中的33例、19例IA2A阳性中15例及16例ZnT8A阳性中的14例。经典1型糖尿病在发病初至半年内需要胰岛素治疗，而LADA平均在发病3．9年后需要胰岛素治疗。2例FT1D患者起病急，发病时血糖分别为41．1和23．1mmol／L，HbAlc分别为7．8％和6．5％，空腹及餐后血C肽均小于0．03μg／L或不能测出。结论ELISA检0n．0GADA对1型糖尿病的诊断有较高敏感性，联合多种抗体检测对T1DM诊断作用有限。FT1D起病急骤，代谢紊乱更为严重。

Multiple pancreatic islet autoantibodies screening in type 1 diabetes mellitus

Objective To detect multiple islet autoantibodies in patients with type 1 diabetes mellitus （ T1 DM） and to describe clinical feature of subtype T1 DM. Methods Clinical data of 67 cases of type 1 diabetic patients who admitted in our hospital from November 2010 to November 2011 were retrospectively analyzed. Six islet autoantibodies were screened, including islet cytoplasmic antibody （ICA, detected by immune histochemistry method ）, insulin autoimmune antibody （IAA, detected by enzyme- linked immunosorbent assay（ELISA） ）, glutamie decarboxylase antibody （GADA, detected by both ELISA and radio-immune precipitating method（RIP） ） , protein tyrosine phosphatase-2 antibody and zinc transporter 8 antibody（ IA2A and ZnT8A, detected by radio-immune precipitate （RIP） ）. Results Among 67 type 1 diabetic patients, 53 patients were diagnosed as classical T1DM, 12 diagnosed as latent autoimmune diabetes of adults （LADA） and 2 patients fulfilled the criteria for fulminant type 1 diabetes （FT1D）. The onset age was between 2 and 77 years, body mass index （BMI） was （ 22 ± 4 ） kg/m2, level of glyeated hemoglobin Alc（HbAlc） was 9.7% ± 2.4%, and level of fasting serum C-peptide was （0.3 ± 0.4） μg/L, respectively. There were 51 （76. 1% ） , 35 （52. 2% ） , 19 （ 28.3% ）, 16 （ 23.9% ） , 16 （ 23.9 ） and 10 （14. 3%） patents positive for GADA （ELISA）, GADA （RIP）, IA2A, ZnT8A, IAA and ICA, respectively. Fifty-six （83.6%） patients were positive for at least one antibody among four antibodies （ GADA （ ELISA ）, GADA （ RIP）, IA2A, and ZnT8A ）. Fifty-one GADA-positive patients detected by ELISA included 33 cases of 35 cases with positive GADA detected by RIP, 15 cases among 19 cases withpositive IA2A, and 14 cases among 16 cases with positive ZnTSA. Insulin therapy was initiated 3.9 years after onset on average in patients with LADA. The plasma glucose level at onset of the two patients with FT1D was 41.1 and 23. 1 mmol/L, respectively. In contrast, the HbAlc level was 7.8% and 6. 5%, respectively, at diagnosis. The fasting and postprandial serum C-peptide values were lower than 0.03 p,g/L or undetectable in these 2 cases with F1DM. Conclusions GADA detected with ELISA shown higher sensitivity than other 5 antibodies screening, and multiple islet antibodies detection has limited value in diagnosing T1DM. FF1D occurs rapidly with serious metabolic disorders.