胰岛自身抗体定量检测在糖尿病分型诊断中的应用价值

Application of quantitative detection of islet autoantibodies in the diagnosis of diabetes types

目的探讨抗酪氨酸磷酸酶抗体(IA2)、抗胰岛细胞抗体(ICA)、抗胰岛素抗体(IAA)和抗谷氨酸脱羧酶抗体(GADA)及生化指标在糖尿病分型诊断中的应用价值。方法选取2019年9月至2021年6月广州中医药大学第一附属医院收治的195例糖尿病患者作为研究对象。研究对象中2型糖尿病(T2DM)患者150例(T2DM组)、成人隐匿性自身免疫性糖尿病(LADA)患者45例(LADA组),另同时选取体检健康者50例作为对照组。各组分别进行4种胰岛自身抗体、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、糖化血清蛋白(GA)、果糖胺(FRA)、空腹胰岛素、空腹C肽、甘油三酯(TG)、总胆固醇(CHOL)检测并对其结果进行比较分析。结果LADA组的ICA、IAA、GADA阳性率均高于对照组和T2DM组,差异有统计学意义(P<0.05)。LADA组GADA、ICA+GADA、ICA+IAA+GADA阳性率均高于T2DM组,差异有统计学意义(P<0.05)。LADA组的ICA、GADA水平均高于对照组和T2DM组,差异有统计学意义(P<0.05)。LADA组HbA1c、GA、FRA、FBG水平均高于T2DM组,空腹胰岛素、空腹C肽、TG水平均低于T2DM组,差异有统计学意义(P<0.05)。LADA组患者的GADA水平与HbA1c、GA、FRA、FBG呈正相关(P<0.05),与空腹胰岛素、空腹C肽呈负相关(P<0.05);而LADA组患者的ICA、IAA水平与各生化指标均无相关性(P>0.05)。结论胰岛自身抗体联合生化指标的定量检测对糖尿病初期LADA的鉴别诊断和胰岛β细胞功能预判具有重要价值,对LADA的早期诊断和早期治疗有一定的指导意义。

Objective To investigate the application value of anti-tyrosine phosphatase antibody(IA2),isletcell antibody(ICA),insulin autoantibodies(IAA)and glutamate decarboxylase antibody(GADA)and biochemical indicators in the diagnosis of diabetes.Methods A total of 195 diabetic patients admitted to the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from September 2019 to June 2021 were selected as the research subjects.150 patients with type 2 diabetes mellitus(T2DM group)and 45 patients with latent autoimmune diabetes in adults(LADA group)were included in the study,and 50 healthy subjects were selected as control group.All cases were tested for 4 islet autoantibodies,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),glycosylated serum protein(GA),fructosamine(FRA),fasting insulin,fasting C-peptide,triglyceride(TG)and total cholesterol(CHOL)were detected in each group,and the results were compared and analyzed.Results The positive rates of ICA,IAA and GADA in the LADA group were higher than those in the control group and T2DM group,and the difference was statistically significant(P<0.05).The positive rates of GADA,ICA+GADA,ICA+IAA+GADA in the LADA group were higher than those in the T2DM group,and the difference was statistically significant(P<0.05).The levels of ICA and GADA in the LADA group were higher than those in the control group and T2DM group,and the difference was statistically significant(P<0.05).The levels of HbA1c,GA,FRA,and FBG in the LADA group were higher than those in the T2DM group,and the levels of fasting insulin,fasting C-peptide,and TG were lower than those in the T2DM group,and the differences were statistically significant(P<0.05).The GADA level in the LADA group was positively correlated with HbA1c,GA,FRA,and FBG(P<0.05),and negatively correlated with fasting insulin and fasting C-peptide(P<0.05);while the ICA and IAA level of the LADA group were There was no correlation with each biochemical index(P>0.05).Conclusion The quantitative detection of islet autoantibodies combined with biochemical indicators is of great value for the differential diagnosis of LADA in the early stage of diabetes and the prediction of isletβ-cell function,and has certain guiding significance for the early diagnosis and early treatment of LADA.