三种抗体联合C肽检测诊断糖尿病分型与评估病情的应用价值

Diagnostic value of three antibodies combined with C peptide indiagnosis and classification of diabetes mellitus

目的探讨血清谷氨酸脱羧酶抗体(GAD-Ab)、胰岛素自身抗体(IAA)、胰岛细胞抗体(ICA)联合C肽(C-P)检测诊断糖尿病分型与评估病情的应用价值及临床意义。方法选取2019年4月至2020年10月宿州市第一人民医院103例糖尿病患者作为研究组,其中30例为1型糖尿病(T1DM)组,73例为2型糖尿病(T2DM)组,另选取32例健康体检者设为对照组。比较3组IAA、ICA、GAD-Ab、C-P表达水平,分析IAA、ICA、GAD-Ab、C-P表达水平与糖尿病发病关系,绘制ROC曲线及曲线下面积(AUC),评价IAA、ICA、GAD-Ab、C-P表达水平对T2DM鉴别诊断价值。结果 IAA、ICA、GAD-Ab表达水平比较,T1DM组>T2DM组>对照组,差异有统计学意义(P<0.05)。C-P表达水平比较,T2DM组>T1DM组>对照组,差异有统计学意义(P<0.05)。Logistic回归分析模型显示,IAA、ICA、GAD-Ab、C-P表达水平为糖尿病发病影响因素(P<0.05);ROC曲线发现,IAA、ICA、GAD-Ab、C-P联合检测T2DM的AUC为0.918(95%CI:0.848~0.963),优于IAA、ICA、GAD-Ab单一检测AUC(P<0.05);IAA、ICA、GADAb联合诊断阳性患者空腹血糖(FBG)、2 h血糖(2 hBG)、糖化血红蛋白(HbAlc)水平高于阴性患者,差异有统计学意义(P<0.05)。结论 GAD-Ab、IAA、ICA、C-P联合检测有利于正确鉴别T1DM和T2DM,评估糖尿病病情变化,为糖尿病防治提供科学指导。

Objective To investigate the clinical value of serum glutamic acid decarboxylase antibody(GAD-Ab),insulin autoantibody(IAA),islet cell antibody(ICA) combined with C peptide(C-P) in the diagnosis and classification of diabetes mellitus.Methods From April 2019 to October 2020,103 diabetic patients in suzhou first people’s hospital were selected as the research group,Among them,30 cases were in the type 1 diabetes(T1DM) group and 73 cases were in the type 2 diabetes(T2DM) group,and 32 healthy persons as control group.The expression levels of IAA,ICA,GAD-Ab and C-P in the 3 groups were compared.The relationship between the expression level of IAA,ICA,GAD-Ab and C-P and the incidence of diabetes mellitus was analyzed.The receiver working characteristic(ROC) curve and the area under the curve(AUC) were plotted.Results Comparison of the expression levels of IAA,ICA,and GAD-Ab,T1DM group>T2DM group>control group,the difference was statistically significant(P<0.05).Comparison of C-P expression level,T2DM group>T1DM group>control group,the difference was statistically significant(P<0.05);Logistic regression analysis showed that the expression levels of IAA,ICA,GAD-Ab and C-P were the risk factors for diabetes mellitus(P<0.05).ROC curve showed that AUC of IAA,ICA,GAD AB,C-P combined detection of T2DM was 0.918(95% CI:0.848-0.963),which was better than that of IAA,ICA,GAD AB single detection of AUC;The levels of FBG,2 HbG and HbAlc in patients with positive IAA,ICA and GAD AB were higher than those in patients with negative IAA,ICA and GAD AB(P<0.05).Conclusion Combined detection of GAD-Ab,IAA,ICA and C-P is helpful to correctly identify T1DM and T2DM,evaluate the changes of diabetes mellitus,and provide scientific guidance for prevention and treatment of diabetes.