四种胰岛自身抗体诊断成人隐匿性自身免疫性糖尿病的临床意义  

The efficacy of 4 islet autoantibodies in the diagnosis of latent autoimmune diabetes in adults

作　　者：杨琳[1] 周智广[1] 黄干[1] 金萍[1] 亓海英[1] 李霞[1] 陈小燕[1] 

机构地区：[1]中南大学湘雅二医院内分泌科

出　　处：《中华内分泌代谢杂志》2005年第4期327-330,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金项目(30400217);湖南省卫生厅重点项目(9736;2001Z04);湖南省科技厅重点项目(03SSY1009);美国礼来亚洲公司科研基金资助项目(7282/B5KGH0435)

摘　　要：目的探讨应用4种胰岛自身抗体[谷氨酸脱羧酶抗体(GADAb)、羧基肽酶H抗体(CPHAb)、蛋白酪氨酸磷酸酶抗体(IA2Ab)、胰岛素自身抗体(IAA)]诊断成人隐匿性自身免疫性糖尿病(LADA)的策略。方法选择临床2型糖尿病(DM)患者1296例,1型DM患者110例,健康对照205名。用35S甲硫氨酸标记重组人羧基肽酶H(CPH)和谷氨酸脱羧酶(GAD65),采用放射配体法检测所有患者血清的CPHAb和GADAb;其中545例还检测蛋白酪氨酸磷酸酶抗体(IA2Ab),98例检测胰岛素自身抗体(IAA),均采用放射配体法检测。结果临床2型DM患者的GADAb阳性率9.0%(117/1296)高于CPHAb4.8%(62/1296,P<0.01),二者均高于健康对照(P<0.01和0.05);IA2Ab和IAA频率分别为1.3%(7/545)和0%(0/98),低于CPHAb(P<0.01)。在2型DM患者中IA2Ab与GADAb的重叠率为57.1%(4/7),高于CPHAb8.1%(5/62,P<0.01)。GADAb和CPHAb联合检测阳性率达15.0%(82/545),与三抗体联合(GADAb+CPHAb+IA2Ab)检测15.6%(85/545)差异无统计学意义(P>0.05),而显著高于GADAb联合IA2Ab或CPHAb联合IA2Ab检测阳性率(比10.3%和比6.6%,均P<0.01)。结论单一抗体诊断LADA的敏感性为GADAb>CPHAb>IA2Ab>IAA。临床筛查LADA以联合检测GADAb和CPHAb的效率最佳。采用IA2Ab和IAA诊断LADA的效率低,临床可考虑不予常规检测。Objective To explore the diagnostic strategies of latent autoimmune diabetes in adults （LADA） with four kinds of islet autoantibodies. Methods A total of 1296 patients with type 2 diabetes mellitus （DM） , 110 type 1 DM patients and 205 healthy controls were recruited. Recombinant human carboxypeptidase-H （CPH） and glutamic acid decarboxylase （GAD65） were labeled with ^35S-methionine and used to evaluate autoantibodies to CPH （CPH-Ab） and GAD （GAD-Ab） in all the patients by radioligand assay （RLA）. In addition, protein tyrosine phosphatase antibody （IA-2Ab） and insulin autoantibody （IAA） were assayed by RLA in 545 and 98 type 2 DM patients respectively. Results In type 2 DM patients 9.0% （ 117/1296） were positive for GAD-Ab, being significantly higher than 4.8% （62/1296） for CPH-Ab （P〈0.01）, both results were higher than those of healthy controls （P〈0.05 or 0.01 respectively）. The prevalences of IA-2Ab and IAA were 1.3% （7/545） and 0% （ 0/98 ） respectively, both being lower than that of CPH-Ab （ P〈0.01 ）. The overlapping positive rate between IA-2Ab and GAD-Ab was 57.1% （4/7） , being higher than that between IA-2Ab and CPH-Ab of 8.1% （5/62） （ P〈0.01 ）. The combined positiveness of GAD-Ab and CPH-Ab were 15.0% （ 82/545 ） , being not significantly different with that of GAD-Ab, CPH-Ab and IA-2Ab combined 15.6% （85/545, P〉0.05 ） , but significantly higher than that of GAD-Ab and IA-2Ab or CPH-Ab and IA-2Ab combined （ vs 10.3% ＆ 6.6% , both P〈0.01 ）. Conclusion The diagnostic sensitivity for LADA with single antibody is as followed ： GAD-Ab〉CPH-Ab〉IA-2Ab〉 IAA. Combined analysis of GAD-Ab and CPH-Ab is the most effective way for screening LADA patients. IA-2Ab and IAA are not recommended for routine screening as they have low diagnostic efficacy for LADA.

关 键 词：胰岛自身抗体 成人隐匿性自身免疫性糖尿病 谷氨酸脱羧酶抗体 羧基肽酶H抗体 蛋白酪氨酸磷酸酶抗体 

分 类 号：R587.1[医药卫生—内分泌]