胰岛自身抗体和生化指标在糖尿病分型诊断中的应用价值

Application value of serum pancreatic isled autoantibodies and biochemical indicators in classification diagnosis of diabetes mellitus

目的探讨胰岛自身抗体与生化指标在1型糖尿病（T1DM）和2型糖尿病（T2DM）临床分型诊断中的应用价值。方法回顾性分析99例T1DM患者（T1DM组）与577例T2DM患者（T2DM）的临床资料及实验室检测结果,比较两组胰岛自身抗体及各项生化指标水平,并分析其特征。结果 T1DM组患者血清谷氨酸脱羧酶抗体（GADA）、胰岛细胞瘤相关蛋白-2自身抗体（IA-2A）、抗胰岛细胞抗体（ICA）及锌转运体8自身抗体（ZnT8A）单项及联合检测的阳性率均高于T2DM组,差异均有统计学意义（P〈0.05）。T1DM组患者起病年龄、空腹C肽（CP）、餐后2hCP、空腹胰岛素（INS）、餐后2hINS、三酰甘油（TG）和体质量指数（BMI）均低于T2DM组,空腹血糖、餐后2h血糖、糖化血红蛋白（HbA1c）及高密度脂蛋白胆固醇（HDL-C）水平均高于T2DM组,差异均有统计学意义（P〈0.05）;而两组总胆固醇、低密度脂蛋白胆固醇水平比较,差异均无统计学意义（P〉0.05）。空腹CP及餐后2hCP水平在T1DM组均随着病程延长呈下降趋势,且不同病程间比较,差异均有统计学意义（P〈0.05）;而在T2DM组无明显的下降趋势。病程小于2年的患者空腹CP、餐后2hCP鉴别诊断T1DM与T2DM的受试者工作曲线下面积及其95%置信区间分别为0.902（0.850-0.954）、0.905（0.852-0.958）。当空腹CP诊断界点为0.283nmol/L时,其灵敏度和特异度分别为82.6%、89.2%;餐后2hCP诊断界点为0.421nmol/L时,其灵敏度和特异度分别为84.8%、89.2%。结论T1DM、T2DM患者的起病年龄、BMI值及血清GADA、IA-2A、ICA、ZnT8A、INS、CP、葡萄糖、HbA1c、TG、HDL-C水平等指标存在差异,可辅助临床对其进行分型诊断。

Objective To investigate the application value of serum pancreatic isled autoantibodies and biochemical indicators in classification diagnosis of type 1diabetes mellitus（T1DM）and type 2diabetes mellitus（T2DM）.Methods The clinical data and laboratory detection results in 99 cases of T1 DM and 577 cases of T2 DM were retrospectively analyzed.The levels of pancreatic isled autoantibodies and biochemical indicators were compared between the two groups and their characteristics were analyzed.Results The positive rates of single detection and combine detection of glutamic acid decarboxylase autoantibodies（GADA）,insulinoma-associated antigen-2autoantibodies（IA-2A）,islet cell autoantibodies（ICA）and ZnT8autoantibodies（ZnT8A）in the T1 DM group were higher than those in the T2 DM group,the differences were statistically significant（P〈0.05）.The onset age,fasting and postprandial 2hCP,fasting and postprandial 2hinsulin（2hINS）,triglyceride（TG）and body mass index（BMI）in the T1 DM group were lower than those in the T2 DM group,while the levels of fasting and postprandial 2hblood glucose,glycosylated hemoglobin（HbA1c）and high-density lipoprotein cholesterol（HDL-C）were higher than those in the T2 DM group,the differences were statistically significant（P〈0.05）;however total cholesterol and low-density lipoprotein cholesterol levels had no statistical difference between the T1 DM group and T2 DM group（P〈0.05）.Moreover,the fasting and postprandial 2hCP levels in the T1 DM group showed decreasing trend as the T1 DM course extending,and the difference had statistical difference among different disease courses;but the fasting and postprandial 2hCP levels in the T2 DM group had no obvious decreasing trend.The areas under the receiver operating characteristic（ROC）curve of fasting and postprandial 2hCP for differential diagnosis of T1 DM and T2 DM in the patients with the disease course 2year were 0.902（95%CI：0.850-0.954）and 0.905（95%CI：0.852-0.958）respectively.The suitable threshold value of fasting CP was 0.283nmol/L,its sensitivity and specificity were 82.6% and 89.2%,respectively,which of postprandial 2 h CP was 0.421 nmol/L,its sensitivity and specificity were 84.8% and 89.2% respectively.Conclusion T1 DM and T2 DM are different in onset age,BMI value,serum GADA,IA-2A,ICA,ZnT8 A,insulin,CP,glucose,HbA1 c,TG and HDL-C levels,which may assist clinic in their classification diagnosis.