胰岛素自身抗体临床检测应用局限及对策研究进展

Study on detection of insulin autoimmune antibodies:limitation and countermeasures

胰岛素自身抗体(insulin autoimmune antibodies,IAA)常用于1型糖尿病(type 1 diabetes mellitus,T1DM)的诊断、发病风险评估,以及疾病转归的预判,也可用于胰岛素自身免疫综合征(insulin autoimmune syndrome,IAS)和外源性胰岛素抗体综合征(exogenous insulin antibodies syndrome,EIAS)的诊断。但现有的临床检测技术存在局限,即不能区分IAA亚型,故其在T1DM的预测和诊断中存在不确定性。此外,临床上不乏T1DM合并EIAS、糖尿病合并IAS的现象,这对区分内源性(T1DM及IAS)与外源性(EIAS)病因所导致的IAA抗体亚型检测,同样提出了挑战。近年来,IAA亲和力、同种型和抗原表位等相关分型研究进展,提供了可行的实验室检测途径和临床应用对策,值得关注。

Insulin autoimmune antibodies(IAA)detection are commonly applied to diagnosis of type 1 diabetes mellitus(T1DM),prediction of incidence risk and disease outcomes.It can also be used for the diagnosis of insulin autoimmune syndrome(IAS)and exogenous insulin antibodies syndrome(EIAS).The problem is that IAA has different subtypes which may lead to uncertainties in the prediction and diagnosis of T1DM since the existing clinical detection technology is limited to subdivide them.Meanwhile,the diabetes complicated with IAS or T1DM complicated with EIAS bring more difficulty in detecting IAA subtype as differentiating endogenous etiology(T1DM and IAS)from exogenous etiology(EIAS).In recent years,the studies on IAA affinity,isotype and antigenic epitope may enable laboratory detection to classify IAA groups,which is worth paying attention to.