胰岛自身抗体检测在成人隐匿性自身免疫糖尿病中的诊断价值

Diagnostic value of islet autoantibodies in adults with latent autoimmune diabetes mellitus

目的探讨胰岛自身抗体检测对成人隐匿性自身免疫糖尿病（latentautoimmunediabetesmellitus，LADA）的诊断价值。方法选取2014年7月～2015年10月浙江省临海市第一人民医院收治的80例初诊为T2DM（2型糖尿病）患者作为研究组，选取同期80例糖耐量正常者作为对照组，测定并比较2组受试者血清抗胰岛素抗体（IAA）、胰岛细胞抗体（ICA）、谷氨酸脱羧酶抗体（GADA），并给予C肽释放试验以及胰岛素释放试验。结果研究组IAA、ICA、GADA的阳性率及≥1种抗体阳性者比例均显著高于对照组；研究组血清中≥1种胰岛素自身抗体阳性者的C肽分泌水平和胰岛素水平较对照组明显下降，且3种抗体全阳性组的下降幅度最为明显。结论临床初诊为2型糖尿病患者存在成人隐匿性自身免疫糖尿病误诊的可能性，联合检测多种胰岛素自身抗体，有利于LADA的鉴别诊断。

Objective To investigate the diagnostic value of islet autoantibodies in adults with latent autoimmune diabetes mellitus(LADA).Methods80cases of newly diagnosed T2DM(type2diabetes)from July2014to October2015in our hospital were selected as the study group,and80cases of normal glucose tolerance in the same period were selected as the control group,serum insulin antibody(IAA)and islet cell antibody(ICA),glutamic acid decarboxylase antibody(GADA)were measured and compared between the two groups of subjects,and C peptide release test and insulin release test were performed in two groups.Results The proportion of positive rate of study group IAA,ICA,GADA and more than1kinds of antibodies were significantly higher than the control group;C peptide positive autoantibodies in the serum of study group than the secretion of insulin and the insulin level was lower than the control group,and the3kinds of antibody positive group decreased most obviously.Conclusion The clinical diagnosis of type2diabetes mellitus is the possibility of misdiagnosis of latent autoimmune diabetes in adults,and it is helpful for differential diagnosis of LADA by combined detection of multiple insulin autoantibodies.