胰岛自身抗体测定对成人隐匿性自身免疫糖尿病的诊断价值

Significance of determination islet autoantibodies in the diagnosis of LADA

目的:探讨谷氨酸脱羧酶抗体(GADA)、胰岛细胞抗体(ICA)和抗胰岛素抗体(IAA)在成人隐匿性自身免疫糖尿病(LADA)诊断中的价值。方法:入选150例初诊为2型糖尿病(T2DM)的患者和80例正常糖耐量者,测定其血清GADA、ICA和IAA,并行胰岛素释放试验及C肽释放试验。结果:初诊为T2DM患者血清中GADA、ICA及IAA抗体的阳性率分别为20.0%、14.0%和8.0%,有一种或以上抗体阳性者占30%。与对照组比较,血清中有一种或以上胰岛自身抗体阳性的DM患者的胰岛素和C肽分泌水平明显下降,其中三种抗体全阳性组患者下降最为显著,差别均有统计学意义(P<0.01)。结论:临床初诊为T2DM的病人中存在被误诊的LADA患者,多种胰岛自身抗体联合检测可提高LADA的检出率。

Objective：To explore the significance of determination of glutamic acid decarboxylase antibody（GADA）,islet cell antibody（ICA） and insulin autoantibody（IAA） in diagnosis of latent autoimmune diabetes in adult（LADA）.Methods： One hundred and fifty newly type 2 diabetes mellitus（T2DM） patients and eighty cases of healthy persons were enrolled.The levels of GADA,ICA and IAA in the blood were estimated.The insulin releasing test and C-peptide releasing test were done at the same time.Results： The positive rates of GADA,ICA and IAA were 20.0%,14.0% and 8.0%,respectively.There are 30% DM patients who had one or more islet autoantibodies in the blood.Compared with control group,patients who had one or more islet autoantibodies in the blood had lower fasting and postprandial insulin and C-peptide levels.Those who had three kinds of islet autoantibodies in the blood,had the lowest insulin and C-peptide levels（P〈0.01）.Conclusion： There are LADA patients who was misdiagnosis to be T2DM.Combined detection of multiple islet autoantibodies can increase the detection rate of LADA.