三种胰岛自身抗体联合检测对于LADA早期诊断的意义

The Significance of Combined Determination of Three Islet Autoantibodies in Early LADA

目的 探讨联合检测谷氨酸脱羧酶抗体 (GADA) ,胰岛素细胞抗体 (ICA)和胰岛自身抗体 (IAA)对于从临床诊断为Ⅱ型糖尿病 (DM)的患者中发现成人隐匿性自身免疫性糖尿病 (LADA)意义。方法 选择从2 0 0 1年 2月～ 12月在本院住院的诊断为Ⅱ型DM患者 (依据 1985年WHO糖尿病诊断标准 ) 12 0例 ,正常对照6 0例。用间接酶联免疫法分别检测GADA、ICA和IAA。用放射免疫法分别检测抗体阳性组 (三种抗体中一种以上阳性 )和抗体阴性组的空腹和餐后 2h的血清C肽。结果 ①在 12 0例Ⅱ型DM中 ,2 8 3%抗体阳性 ;②抗体阳性组血清C肽水平 [空腹 (6 87 4± 4 4 4 9) ,餐后 2h (16 0 8 7± 1173 3) ]明显低于抗体阴性组 [空腹(898 6± 5 16 5 ) ,餐后 2h (2 112 8± 10 2 1 3) ](P <0 0 1)。结论 参照LADA诊断的血清学标准 ,本组既往诊断为Ⅱ型DM患者中 2 8 3%应为LADA。因此对临床诊断为Ⅱ型DM的患者早期联合检测三种胰岛自身抗体 ,有助于LADA的鉴别诊断。

Objective To evaluate the significance of combined determination of glutamic acid decarvoxyalso antibodies (GADA), islet cell antibodies (ICA) and in sulin awtoantibodies (IAA) in early typeⅡ diabetes mellitus. Methods According to the morphologic criteria of World Health Organization (WHO) Diagnosis Diabetes Mellitus of 1985,120 patients with typeⅡ diabetes from Feb.2001 to Dec.2001 were chosen in this trial.In addition,60 people were taken as normal controls.GADA,ICA and IAA were determined by indirect enzyine-linked immunosorbent assay (ELISA) and c-peptide by radioimmunoassay (RIA).Results ①Among 120 patients diagnosed as type Ⅱ diabetes 28.3% showed at least one antibody positive. ②Fasting and postprandial c-peptide of antibody positive patients were significantly lower than that of antibodies negative patients (P<0.01).Conclusions According to the criteria of the diagnosis of LADA 28.3% patients of typeⅡ diabets should be diagnosed as LADA. Among the patients with typeⅡ diabetes mellitus combined detection of the antoantibodies would be helpful for diagnosis of LADA.