成人隐匿性自身免疫糖尿病实验室诊断的临床意义

Clinical Significance of Laboratory Diagnosis of Adult Hiding Own Immunity Diabetes

目的探讨临床初诊为2型糖尿病(type 2 diabetes mellitus,T2DM)患者中成人隐匿性自身免疫糖尿病(latent autoimmune diabetes in adult,LADA)的患病率及与自身抗体的关系。方法对1221例临床初诊为T2DM患者采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)测定谷氨酸脱羧酶抗体(glutamic acid decarboxylase antibody,GAD-Ab)和酪氨酸磷酸酶抗体(tyrosine phosphatase antibody,IA2-Ab)水平,了解LADA患病率并分析其临床特征。结果 LADA检出率为8.27%(101/1221),其中GAD-Ab和IA2-Ab的阳性检出率分别为5.57%和0.90%。两种抗体阳性检出率在25～40岁年龄段最高,之后抗体阳性率随发病年龄的增加而下降。抗体阳性组患者空腹C肽及餐后2 h C肽值均明显低于抗体阴性组患者。结论自身抗体阳性的T2DM患者存在明显的胰岛功能损伤,早期检出LADA对指导治疗及改善预后具有重要意义。

Objective To discuss the incidence of latent autoimmune diabetes in adult（LADA） in adult patients with new diagnosis of type 2 diabetes mellitus（T2DM） and its relation with the autoantibody.Methods The glutanic acid decarboxylase immune body（GAD-Ab） and the tyrosine phosphatase antibody（IA2-Ab） levels in 1221 patients firstly diagnosed as with T2DM were tested by enzyme-linked immunosorbent assay（ELISA）.The incidence of LADA was recorded and its clinical characteristics were analyzed.Results The detection rate of LADA was 8.27%（101/1221）.The positive rates of GAD-Ab and IA2-Ab were 5.56% and 0.90% respectively.The positive rates were highest in patients with 25-40 years of age,and then decreased with the increase of age.The fasting C-peptide and 2 h postprandial C-peptide of patients with positive autoantibodies were significantly lower than those of patients with negative autoantibodies.Conclusion T2DM patient with positive autoantibodies have obvious islet dysfunction.Early detection of LADA is critical to instruct the treatment and improve the prognosis.