CAJ | 학술논문

目的分析1型糖尿病(T1DM)患者多种胰岛自身抗体的检出情况和不同类型T1 DM的临床特征.方法选取2010年11月至2011年11月在中日友好医院住院的67例T1DM患者,分析其临床特征及胰岛细胞抗体(ICA)、胰岛素抗体(IAA)、谷氨酸脱羧酶抗体(GADA)[酶联免疫吸附试验(ELISA)法和免疫沉淀法(RIP)检测]、蛋白酪氨酸磷酸酶抗体(IA2A)和锌转运蛋白8抗体(ZnT8A)等6种胰岛自身抗体情况.结果本组T1DM共67例,其中经典型T1 DM 53例,成人迟发性自身免疫糖尿病(LADA) 12例和暴发性1型糖尿病(FTlD)2例.起病年龄2～77岁,体质指数(BMI) (22±4)kg/m2,糖化血红蛋白(HbAlc)9.7％±2.4％,空腹C肽(0.3±0.4)μg/L.GADA(ELISA)阳性51例(76.1％),GADA (RIP)阳性35例(52.2％),IA2A阳性19例(28.3％),ZnT8A阳性16例(23.9％),IAA阳性16例(23.9％),ICA阳性10例(14.3％).前4种抗体检测方法至少1种阳性者共56例(83.6％).51例ELISA法GADA阳性包括了35例RIP检测GADA阳性中的33例、19例IA2A阳性中15例及16例ZnT8A阳性中的14例.经典1型糖尿病在发病初至半年内需要胰岛素治疗,而LADA平均在发病3.9年后需要胰岛素治疗.2例FT1D患者起病急,发病时血糖分别为41.1和23.1 mmol/L,HbAlc分别为7.8％和6.5％,空腹及餐后血C肽均小于0.03 μg/L或不能测出.结论 ELISA检测GADA对1型糖尿病的诊断有较高敏感性,联合多种抗体检测对T1 DM诊断作用有限.FTlD起病急骤,代谢紊乱更为严重.
목적 분석1형당뇨병(T1DM)환자다충이도자신항체적검출정황화불동류형T1 DM적림상특정.방법 선취2010년11월지2011년11월재중일우호의원주원적67례T1DM환자,분석기림상특정급이도세포항체(ICA)、이도소항체(IAA)、곡안산탈최매항체(GADA)[매련면역흡부시험(ELISA)법화면역침정법(RIP)검측]、단백락안산린산매항체(IA2A)화자전운단백8항체(ZnT8A)등6충이도자신항체정황.결과 본조T1DM공67례,기중경전형T1 DM 53례,성인지발성자신면역당뇨병(LADA) 12례화폭발성1형당뇨병(FTlD)2례.기병년령2～77세,체질지수(BMI) (22±4)kg/m2,당화혈홍단백(HbAlc)9.7％±2.4％,공복C태(0.3±0.4)μg/L.GADA(ELISA)양성51례(76.1％),GADA (RIP)양성35례(52.2％),IA2A양성19례(28.3％),ZnT8A양성16례(23.9％),IAA양성16례(23.9％),ICA양성10례(14.3％).전4충항체검측방법지소1충양성자공56례(83.6％).51례ELISA법GADA양성포괄료35례RIP검측GADA양성중적33례、19례IA2A양성중15례급16례ZnT8A양성중적14례.경전1형당뇨병재발병초지반년내수요이도소치료,이LADA평균재발병3.9년후수요이도소치료.2례FT1D환자기병급,발병시혈당분별위41.1화23.1 mmol/L,HbAlc분별위7.8％화6.5％,공복급찬후혈C태균소우0.03 μg/L혹불능측출.결론 ELISA검측GADA대1형당뇨병적진단유교고민감성,연합다충항체검측대T1 DM진단작용유한.FTlD기병급취,대사문란경위엄중.
Objective To detect multiple islet autoantibodies in patients with type 1 diabetes mellitus (T1DM) and to describe clinical feature of subtype T1DM.Methods Clinical data of 67 cases of type 1 diabetic patients who admitted in our hospital from November 2010 to November 2011 were retrospectively analyzed.Six islet autoantibodies were screened,including islet cytoplasmic antibody (ICA,detected by immune histochemistry method),insulin autoimmune antibody (IAA,detected by enzymelinked immunosorbent assay(ELISA)),glutamic decarboxylase antibody (GADA,detected by both ELISA and radio-immune precipitating method(RIP)),protein tyrosine phosphatase-2 antibody and zinc transporter 8 antibody(IA2A and ZnT8A,detected by radio-immune precipitate (RIP)).Results Among 67 type 1 diabetic patients,53 patients were diagnosed as classical T1DM,12 diagnosed as latent autoimmune diabetes of adults (LADA) and 2 patients fulfilled the criteria for fulminant type 1 diabetes (FT1D).The onset age was between 2 and 77 years,body mass index (BMI) was (22 ± 4) kg/m2,level of glycated hemoglobin Alc(HbAlc) was 9.7％ ± 2.4％,and level of fasting serum C-peptide was (0.3 ± 0.4) μg/L,respectively.There were 51 (76.1％),35 (52.2％),19 (28.3％),16 (23.9％),16 (23.9) and 10 (14.3％) patents positive for GADA (ELISA),GADA (RIP),IA2A,ZnT8A,IAA and ICA,respectively.Fifty-six (83.6％) patients were positive for at least one antibody among four antibodies (GADA (ELISA),GADA (RIP),IA2A,and ZnT8A).Fifty-one GADA-positive patients detected by ELISA included 33 cases of 35 cases with positive GADA detected by RIP,15 cases among 19 cases with positive IA2A,and 14 cases among 16 cases with positive ZnT8A.Insulin therapy was initiated 3.9 years after onset on average in patients with LADA.The plasma glucose level at onset of the two patients with FT1D was 41.1 and 23.1 mmol/L,respectively.In contrast,the HbA1c level was 7.8％ and 6.5％,respectively,at diagnosis.The fasting and postprandial serum C-peptide values were lower than 0.03 μg/L or undetectable in these 2 cases with F1 DM.Conclusions GADA detected with ELISA shown higher sensitivity than other 5 antibodies screening,and multiple islet antibodies detection has limited value in diagnosing T1DM.FT1D occurs rapidly with serious metabolic disorders.