5种胰岛自身抗体在糖尿病患者血清中检测的临床意义

Clinical significance of detection of five kinds of serum pancreas islet auto-antibodies in patients with diabetes mellitus

目的观察酪氨酸磷酸酶抗体(IA-2A)、谷氨酸脱羧酶抗体(GADA)、胰岛细胞抗体64KD(ICA-64KD)、胰岛细胞抗体40KD(ICA-40KD)、胰岛素抗体(IAA)在1型糖尿病(T1DM)、2型糖尿病(T2DM)和健康人群中的阳性检出率并探讨其临床意义。方法采用免疫印迹法检测22例T1DM(T1DM组)、160例T2DM(T2DM组)及20例健康人群(健康对照组)血清中的IA-2A、GADA、ICA-64KD、ICA-40KD和IAA的阳性检出率,并对其结果进行分析。结果 T1DM组IA-2A、GADA、ICA-64KD、ICA-40KD和IAA这5种胰岛自身抗体阳性检出率分别为45.5%、72.7%、45.5%、9.1%和9.1%;T2DM组阳性检出率依次为23.8%、28.8%、8.8%、3.8%、3.8%,健康对照组的这5种胰岛自身抗体阳性检出率均为0%。IA-2A阳性检出率T1DM组高于健康对照组(P=0.002),GADA阳性检出率T1DM组和T2DM组均高于健康对照组(P<0.01,P=0.005),T1DM组高于T2DM组(P<0.01),ICA-64KD阳性检出率T1DM组高于健康对照组(P=0.002)和T2DM组(P<0.01),其余各组间比较差异无统计学意义(P>0.017)。结论 GADA和IA-2A对T1DM有诊断价值,GADA对T2DM也有诊断意义,GADA和ICA-64KD对T1DM和T2DM具有鉴别诊断意义。

Objective To observe the positive rates of five kinds of serum pancreas islet auto‐antibodies IA‐2A ,GADA ,ICA‐64KD ,ICA‐40KD ,IAA in type 1 diabetes mellitus（T1DM ） ,type 2 diabetes mellitus（T2DM ） and the normal population and their clinical significance .Methods The above 5 kinds of serum auto‐antibodies were detected in 22 cases of T1DM ,160 cases of T2DM and 20 healthy people by using the immunoblotting test .Then the detection results were analyzed .Results The positive rates of IA‐2A ,GADA ,ICA‐64KD ,ICA‐40KD and IAA were 45 .5% ,72 .7% ,45 .5% ,9 .1% and 9 .1% respectively in the T1DM group , 23 .8% ,28 .8% ,8 .8% ,3 .8% and 3 .8% respectively in the group T2DM ,and 0% in the normal control group .The IA‐2A positive rate in the T1DM group was higher than that in the healthy control group（P ＆lt; 0 .05） .The positive rate of GADA in the T1DM group and T2DM group was higher than that in the healthy control group（P〈 0 .01 ,P= 0 .005） ,the T1DM group was higher than the T2DM group（P〈0 .01） ,the positive rate of ICA‐64KD in the T1DM group was higher than that in the healthy control group and the T2DM group（P = 0 .002 ,P 〈0 .01） ,the differences in the comparison among other groups had no statistical significance （P〉0 .017） .Conclusion GADA and IA‐2A have the diagnostic value to T1DM ,GADA also has the diagnostic significance to T2DM ,GADA and ICA‐64KD have the differentiating diagnostic significance to T1DM and T2DM .