胰岛细胞抗体亚型与胰岛素、胰高血糖素分泌的关联

Association between islet cell antibody subtypes and secretions of insulin and glucagon

目的 通过研究胰岛细胞抗体 (ICA)不同亚型阳性患者胰岛素、胰高血糖素水平的差异 ,探讨成人隐匿性自体免疫性糖尿病 (LADA)的发病机制。方法 免疫组化法测定的ICA边缘型阳性LADA患者 2 9例、弥漫型阳性LADA患者 2 8例、ICA阴性正常人 17例分为 3组 ,测定空腹、餐后 3 0、60、12 0min血糖、胰岛素、胰高血糖素。结果 ( 1)与对照组比较 ,ICA阳性两组的胰高血糖素曲线下面积 (AUC)均高于对照组 (均P <0 .0 5 ) ;餐后 3 0、60min胰岛素 :对照 >边缘型阳性 >弥漫型阳性 ;( 2 )多元逐步回归显示胰岛素、胰岛素 /胰高血糖素 (AUC ,60、12 0min)均与ICA亚型、胰岛素敏感性显著负相关。结论 ICA边缘型及弥漫型阳性LADA患者中 :( 1)胰高血糖素均高于正常人 ,且两组间差异无显著性 ;( 2 )胰岛素水平均低于正常人 ,但弥漫型阳性者更为明显 ,显示其 β细胞胰岛素分泌功能受损更明显 ;( 3 )对于胰岛素水平的影响 。

Objective To investigate the insulin and glucagon levels in the patients with different islet cell antibody (ICA) subtypes and to explore the pathogenesis of latent autoimmune diabetes of adult (LADA). Methods Subjects were classified by immunohistology and 29 ICA-peripheral-positive DM patients, 28 ICA-diffused-positive DM patients and 17 controls (ICA-negative) were included. Serum glucose, insulin and plasma glucagon were measured at 0, 30, 60, 120 min after standard meal. Results (1) As compared with controls, glucagon in ICA positive groups were higher (both P<0.05); postprandial insulin levels of the peripheral type was lower than control, the diffused type was further lower at 30, 60 min; (2) Stepwise regression showed insulin levels and insulin to glucagon ratios (area under curve, 60、120 min) were negatively correlated with ICA subtypes. Conclusion (1) Glucagon in ICA-positive DM patients was higher than that in controls, and there was no significant difference between the two subtypes. (2) The ICA-positive patients have defects in insulin secretion, the diffused-positive was remarkable because the β-cell deficiency. (3) The effect of insulin sensibitity on insulin level is more significant than the effect of ICA.