以自发酮症起病的新发糖尿病患者的胰岛自身抗体检测  

Detection of islet autoantibody in new-onset diabetic patients with unprovoked ketosis

作　　者：张冬梅[1] 周智广[1] 黄干[1] 王建平[1] 金萍[1] 魏佳莉[1] 胡白瑛[1] 

机构地区：[1]中南大学湘雅二医院代谢内分泌研究所

出　　处：《中华全科医师杂志》2005年第5期273-276,共4页Chinese Journal of General Practitioners

基　　金：国家自然科学基金资助(39370343);卫生部优秀青年科技人才专项科研基金资助(Q9420);湖南省卫生厅科研重点项目(2001Z04)

摘　　要：目的探讨谷氨酸脱羧酶抗体(GAD Ab)、酪氨酸磷酸酶抗体(IA2Ab)和胰岛素自身抗体(IAA)在以自发酮症起病的新发糖尿病患者中的分布规律及其与起病状况、胰腺β细胞功能的关系。方法对161例以自发酮症起病的新发糖尿病患者,以放射配体法测定GAD Ab、IA2Ab和IAA。比较胰岛自身抗体在不同发病年龄组、不同体重指数(BMI)组、不同程度酮症组及不同空腹C肽(FCP)水平组的阳性率,比较胰岛自身抗体阳性与阴性组起病状况和胰腺β细胞功能的差异。结果161例患者中,共68例(42.2%)被检出存在1种或多种胰岛自身抗体,其中胰岛自身抗体在起病年龄≤20岁、BMI≤18.5、FCP水平较低患者中阳性率较高;与胰岛自身抗体阴性组相比,抗体阳性组存在发病年龄较轻、BMI较低、发病时酮症程度较严重、胰岛分泌功能较差等特点。结论在以自发酮症起病的糖尿病患者中,发病年龄较小、BMI较低、C肽水平较低的患者胰岛自身抗体的阳性率较高,属于1A型糖尿病的可能性较大,属于1B型或2型糖尿病的可能性较小。胰岛自身抗体阳性的患者β细胞分泌功能较差,应尽早予胰岛素治疗。Objective To investigate the distribution of islet autoantibodies (GAD-Ab, IA2-Ab, IAA) in new-onset diabetic patients with unprovoked ketosis and their association with clinical characteristics and pancreatic β cell function.Methods Islet autoantibodies, including GAD-Ab、IA2-Ab and IAA were detected in 161 new-onset diabetic patients with unprovoked ketosis by radioligand assay. Prevalence of positive islet autoantibodies was compared among groups with different ages, body mass indexes (BMI), severity of ketosis and fasting C peptide (FCP) levels. Clinical characteristics and pancreatic β cell function were compared between groups with positive and negative islet autoantibodies.Results One or more kinds of islet autoantibodies were detected in 68 from the 161 subjects (42.2%), with higher prevalence of positive islet autoantibodies in the patients aged equal to or less than 20 years, of BMI equal to or less than 18.5 and with FCP equal to or less than 300 pmol/L. Younger age of onset, lower BMI, more severe ketosis and poorer islet endocrine function were found in patients with positive islet autoantibodies, as compared with those with negative ones.Conclusions In diabetic patients with unprovoked ketosis, the younger, the lower C peptide and the lower BMI they are, the higher prevalence of positive islet autoantibodies, the more possibility that they are classified as type 1A diabetes and the less possibility as type 1B diabetes or type 2 diabetes.Pancreatic β cell function was poorer in patients with positive islet autoantibodies,which should be treated with insulin as earlier as possible.

关 键 词：糖尿病患者 自发酮症 自身抗体检测 新发 胰岛自身抗体 谷氨酸脱羧酶抗体 酪氨酸磷酸酶抗体 胰岛素自身抗体 B细胞功能 GAD-Ab 抗体阳性 自身抗体阴性 胰岛分泌功能 1A型糖尿病 细胞分泌功能 发病年龄 放射配体法 2型糖尿病 

分 类 号：R587.2[医药卫生—内分泌]