T2DM患者糖尿病自身抗体检测及其临床价值

Measurement of Autoantibodies and its Clinical Value in Patients with Type 2 Diabetes Mellitus

目的探讨检测糖尿病自身抗体对从2型糖尿病(type 2diabetes mellitus,T2DM)患者中筛查出成人晚发自身免疫性糖尿病(latent autoimmune diabetes in adult,LADA)的价值。方法采用酶联免疫法对73例T2DM患者及30例健康体检者血清谷氨酸脱羧酶抗体(glutamic acid decarboxylase antibody,GADA)、胰岛细胞抗体(islet cell antibody,ICA)、胰岛素自身抗体(insulin autoantibody,IAA)、蛋白酪氨酸磷酸酶抗体(protein tyrosine phosphatase-like IA-2autoantibody,IA-2A)进行检测;分析抗体构成并比较抗体阴性与阳性患者之间的临床差异。结果与对照组比较,T2DM组GADA(19.2%)和IAA(12.3%)两种自身抗体阳性率明显增高,其差异有统计学意义(P<0.05)。单项抗体检测以GADA的阳性率最高(19.2%),两项抗体联合检测以GADA+IAA和GADA+ICA阳性率较高(28.8%和27.4%);3项抗体联合检测以GADA+ICA+IAA阳性率最高(38.4%);4项抗体同时检测阳性率可达39.7%。自身抗体阳性组体质量指数、空腹及餐后120min C肽值均低于自身抗体阴性组(P<0.05),年龄、性别构成比、空腹及餐后120min血糖和病程的差异无统计学意义(P>0.05)。结论糖尿病自身抗体的检测对1型糖尿病(type 1diabetes mellitus,T1DM)的诊断及LADA的筛查具重要临床意义。

Objective To explore the value of measurement of autoantibodies in patients with type 2diabetes mellitus（T2DM）on screening latent autoimmune diabetes in adult（LADA）.Methods Enzyme-linked immune sorbent assay（ELISA）was used to detect the glutamic acid decarboxylase antibodies（GADA）,islet cell antibodies（ICA）,insulin autoantibodies（IAA）,and protein tyrosine phosphatase-like IA-2autoantibody（IA-2A）in 73 patients with T2 DM and 30 healthy people;the constitution of antibodies and clinical differences between antibodynegative and antibody-positive patients were analyzed.Results Compared with control group,the positive rate of GADA（19.2%）and IAA（12.3%）in patients with T2 DM was obviously higher,the differences of which were statistically significant（P〈0.05）.The positive rate of GADA was highest（19.2%）in the single antibody detection;the positive rate of GADA ＋ IAA and GADA ＋ ICA were highest in joint detection of two antibodies combined（28.8%,27.4%）;the positive rate of GADA ＋ICA ＋IAA was highest in detection of three antibodies（38.4 %）;the positive rate reached 39.7%in detection of four antibodies simultaneously.The body mass indexes（BMI,fasting and postprandial 120 min C-peptide values）of autoantibody-positive group were lower than those in autoantibody-negative group（P〈0.05）,and differences among indexes of different age,gender ratio,fasting and postprandial blood glucose 120 min and duration were not statistically significant（P〉0.05）.Conclusion Detection of autoantibodies has clinical significance in the diagnosis of type 1diabetes（T1DM）and screening out LADA.