中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2009年
1期
29-33
,共5页
王霞%黄干%李璋巍%李霞%金河来%周智广
王霞%黃榦%李璋巍%李霞%金河來%週智廣
왕하%황간%리장외%리하%금하래%주지엄
胰岛素抗体%糖尿病,2型%自身免疫疾病
胰島素抗體%糖尿病,2型%自身免疫疾病
이도소항체%당뇨병,2형%자신면역질병
Insulin antibodies%Diabete mellitus,type 2%Autoimmune diseases
目的 探讨胰岛素自身抗体(IAA)对成人隐匿性自身免疫糖尿病(LADA)的诊断价值.方法 选取2003年10月至2007年3月连续在中南大学湘雅二医院就诊的1003例初诊2型糖尿病、110例1型糖尿病患者,并选取同期米院体格检杏的317名健康对照者,采用微量平板放射免疫法和放射配体法检测IAA及谷氨酸脱羧酶抗体(GADA)和蛋门酪氨酸磷酸酶抗体(IA-2A)水平,了解IAA阳性率及与其他抗体重叠情况.对4例IAA单独阳性的LADA患者进行了4年随访,观察其临床特征变化.采用卡方榆验比较初诊2型糖尿病组、健康对照组和初诊1型糖尿病组IAA阳性率,采用t检验比较IAA阳性组和阴性匹配组空腹胰岛素(FINS)水平下降速率.结果 (1)初诊2型糖尿病患者IAA阳性率3.39%(34/1003)高于健康埘照组0.95%(3/317)(X2=5.3,P<0.05),但低于1型糖尿病组21.82%(24/110)(x2=68.2,P<0.01).(2)初诊2型糖尿病患者三种抗体联合检测阳性率为10.47%(105/1003),高于GADA 6.58%(66/1003)、IA-2A 2.79%(28/1003)、IAA3.39%(34/1003)单个抗体检测(x2值分别为9.2、37.8和46.2,P值均<0.05).IAA联合检测可提高LADA阳性检出率2.39%.(3)在4年随访期间,IAA阳性者逐年转阴,4例中的2例患者合并GADA阳性;IAA阳性组FINS水平下降速率较阴性匹配组呈增高趋势(分别为15.37%和5.29%;t=1.7,P=0.059).结论 IAA对初诊2型糖尿病患者筛查LADA有一定价值;联合检测IAA、GADA、IA-2A能提高LADA诊断效率.
目的 探討胰島素自身抗體(IAA)對成人隱匿性自身免疫糖尿病(LADA)的診斷價值.方法 選取2003年10月至2007年3月連續在中南大學湘雅二醫院就診的1003例初診2型糖尿病、110例1型糖尿病患者,併選取同期米院體格檢杏的317名健康對照者,採用微量平闆放射免疫法和放射配體法檢測IAA及穀氨痠脫羧酶抗體(GADA)和蛋門酪氨痠燐痠酶抗體(IA-2A)水平,瞭解IAA暘性率及與其他抗體重疊情況.對4例IAA單獨暘性的LADA患者進行瞭4年隨訪,觀察其臨床特徵變化.採用卡方榆驗比較初診2型糖尿病組、健康對照組和初診1型糖尿病組IAA暘性率,採用t檢驗比較IAA暘性組和陰性匹配組空腹胰島素(FINS)水平下降速率.結果 (1)初診2型糖尿病患者IAA暘性率3.39%(34/1003)高于健康塒照組0.95%(3/317)(X2=5.3,P<0.05),但低于1型糖尿病組21.82%(24/110)(x2=68.2,P<0.01).(2)初診2型糖尿病患者三種抗體聯閤檢測暘性率為10.47%(105/1003),高于GADA 6.58%(66/1003)、IA-2A 2.79%(28/1003)、IAA3.39%(34/1003)單箇抗體檢測(x2值分彆為9.2、37.8和46.2,P值均<0.05).IAA聯閤檢測可提高LADA暘性檢齣率2.39%.(3)在4年隨訪期間,IAA暘性者逐年轉陰,4例中的2例患者閤併GADA暘性;IAA暘性組FINS水平下降速率較陰性匹配組呈增高趨勢(分彆為15.37%和5.29%;t=1.7,P=0.059).結論 IAA對初診2型糖尿病患者篩查LADA有一定價值;聯閤檢測IAA、GADA、IA-2A能提高LADA診斷效率.
목적 탐토이도소자신항체(IAA)대성인은닉성자신면역당뇨병(LADA)적진단개치.방법 선취2003년10월지2007년3월련속재중남대학상아이의원취진적1003례초진2형당뇨병、110례1형당뇨병환자,병선취동기미원체격검행적317명건강대조자,채용미량평판방사면역법화방사배체법검측IAA급곡안산탈최매항체(GADA)화단문락안산린산매항체(IA-2A)수평,료해IAA양성솔급여기타항체중첩정황.대4례IAA단독양성적LADA환자진행료4년수방,관찰기림상특정변화.채용잡방유험비교초진2형당뇨병조、건강대조조화초진1형당뇨병조IAA양성솔,채용t검험비교IAA양성조화음성필배조공복이도소(FINS)수평하강속솔.결과 (1)초진2형당뇨병환자IAA양성솔3.39%(34/1003)고우건강시조조0.95%(3/317)(X2=5.3,P<0.05),단저우1형당뇨병조21.82%(24/110)(x2=68.2,P<0.01).(2)초진2형당뇨병환자삼충항체연합검측양성솔위10.47%(105/1003),고우GADA 6.58%(66/1003)、IA-2A 2.79%(28/1003)、IAA3.39%(34/1003)단개항체검측(x2치분별위9.2、37.8화46.2,P치균<0.05).IAA연합검측가제고LADA양성검출솔2.39%.(3)재4년수방기간,IAA양성자축년전음,4례중적2례환자합병GADA양성;IAA양성조FINS수평하강속솔교음성필배조정증고추세(분별위15.37%화5.29%;t=1.7,P=0.059).결론 IAA대초진2형당뇨병환자사사LADA유일정개치;연합검측IAA、GADA、IA-2A능제고LADA진단효솔.
Objective To investigate the diagnostic value of insulin autoantibody(IAA) for latent autoimmune diabetes in adults (LADA). Methods Sera of 1003 phenotypie type 2 diabetes mellitus (T2DM) patients from the Second Xiangya Hospital of Central South University were screened for IAA with micro-plate radioimmuneassay. Autoantibodies to glutamic acid deearboxylase (GADA) and autoantibodies to protein tyrosine phosphatase (1A-2A) were analyzed with radioligand assay. Four patients with IAA positive alone were clinically followed up for 4 years. Comparisons between autoantibody status groups used two-sample t tests, or Wilcoxon signed-rank tests for non-normally distributed data. All statistical tests were performed by SPSS 13.0. Results The positivity rate of IAA (3.39%, 34/1003) in clinic-based, phenotypie T2DM patients was higher than that of healthy controls (0.95% ,3/317) (3.39% vs 0.95% , x2 =5.3, P <0.05), but lower than that of type 1 diabetes mellitus (T1 DM) (21.82% ,24/110) (3.39% vs 21.82%, x2 =68.2, P <0.01). The positivity of combining three antibodies was 10.47% (105/1003), higher than 6.58% (66/1003) of GADA alone, 2.79% (28/1003) of lA-2A alone, 3.39% (34/1003) of IAA alone(x2 = 9.2,37.8 and 46.2, respectively, all P < 0.05). Combined IAA measurement increased 2.39% of LADA. The IAA positivity decreased year on year during the peroid of follow-up. During that time, 2 out of 4 patients accompanied by GADA. Average descending rate of fasting insulin levels in IAA positive group was 15.37%, compared with 5.29% of its matched group, and without significant difference (t=1.7, P=0.059). Conclusions IAA can be used to screen LADA in penotypic T2DM in Chinese population. Combined IAA, GADA, and IA-2A testing can improve identifying LADA.
