羧基肽酶-H抗体与LADA患者胰岛β细胞功能关系的横断面研究  

Cross-sectional study of the relation between carboxypeptidase-H antibody and islet β cell function in patients with latent autoimmune diabetes in adults

作　　者：杨琳[1] 周智广[1] 黄干[1] 金萍[1] 亓海英[1] 

机构地区：[1]中南大学湘雅二医院糖尿病中心代谢内分泌研究所,长沙410011

出　　处：《中南大学学报（医学版）》2006年第6期825-829,共5页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(30400217);教育部博士点专项科研基金(20030533033)

摘　　要：目的:探讨羧基肽酶-H自身抗体(CPH-Ab)与成人隐匿性自身免疫性糖尿病(LADA)患者胰岛β细胞功能的关系,以进一步明确其对LADA的诊断价值。方法:选择临床初诊2型糖尿病(T2DM)患者545例,采用放射配体法检测血清CPH-Ab和谷氨酸脱羧酶抗体(GAD-Ab)滴度,以筛出的CPH-Ab阳性患者为病例组,以GAD-Ab阳性患者和抗体阴性的T2DM患者为对照组,比较3组研究对象的胰岛β细胞功能(以空腹和餐后2hC肽值表示),分析CPH-Ab与成人隐匿性自身免疫性糖尿病(LADA)患者胰岛β细胞功能的关系。结果:CPH-Ab阳性患者的空腹C肽介于GAD-Ab阳性与两种抗体(GAD-Ab和CPH-Ab)均阴性的T2DM患者之间(P<0.05),以病程分层后三者的C肽值仍具有统计学意义(均P<0.05),而以BMI分层无明显差异(均P>0.05)。经以年龄、起病年龄、病程、性别等为协变量校正后,3组间的空腹C肽和餐后2hC肽值仍存在显著性差异(均P<0.001),其中CPH-Ab+组仅空腹C肽低于Ab-T2DM组(P<0.05),而GAD-Ab+组空腹和餐后2hC肽均低于Ab-T2DM组(P<0.05和P<0.01)。胰岛素缺乏患者在CPH-Ab+组、GAD-Ab+组和Ab-T2DM组的比例分别为27.6%(8/29),48.1%(8/52)和13.5%(54/400),三者间差异有统计学意义(P(0.001)。多元线性逐步回归分析提示,GAD-Ab,BMI和空腹血糖对T2DM患者的空腹C肽和餐后2hC肽均有影响(均P<0.05),而CPH-Ab与二者均无统计学相关(均P>0.05)。结论:CPH抗体对LADA患者胰岛β细胞功能的影响不如GAD-Ab显著,CPH-Ab对LADA患者胰岛功能衰减的作用需前瞻性研究。Objective To explore the relation between carboxypeptidase-H antibody （CPH- Ab ） and islet β cell function in patients with latent autoimmune diabetes in adults （LADA） and to further confirm the diagnostic value of CPH-Ab for LADA. Methods Five hundred and forty-five patients who were initially diagnosed as Type 2 diabetes mellitus （T2DM） were tested with CPH-Ab and GAD-Ab by r adioligand assay （RLA）. T2DM patients, according to CPH-Ab and GAD-Ab status, were divided into CPH-Ab^＋ group, GAD-Ab^＋ group, and Ab^-group to compare their islet β cell function [ represented by fasting C-peptide （FCP） and 2h postprandial C-peptide （2hCP） ]. The relation between CPH-Ab and islet β cell function in LADA was analyzed. Results The fasting C-peptide level in CPH-Ab^＋ patients was between that of GAD-Ab^＋ patients and that of Ab-patients （ P 〈 0.05 ） , and the difference was still significant when the 3 groups were stratified with duration of disease （ All P 〈 0.05 ） , but not with body mess index （ all P 〉 0.05 ）. Corrected by concomitant variables including age, age at onset, duration of disease, and sex, the differences among the 3 groups were statistically significant （ both P 〈 0.001 ）. Among the 3 groups FCP was lower than Ab- group in CPH-Ab ^＋ （ P 〈 0.05 ） and both FCP and PCP were lower than Ab- group in GAD- Ab ^＋ group （ P 〈 0.05 and P 〈 0.01 ）. The proportions of patients with insulin deficiency in CPH- Ab^-, GAD-Ab^＋, and Ab^- group were 27.6% （8/29）, 48. 1% （8/52） and 13.5% （54/ 400 ） , respectively, which were significantly different among the 3 groups （ P 〈 0.001 ）. GAD- Ab, BMI, and fasting blood glucose had effects on FCP and PCP in T2DM patients （All P 〈 0. 05 ） , while CPH-Ab did not enter the equation in muhivariable stepwise regressive analysis （ P 〉 0.05）. Conclusion The effect of CPH-Ab is less marked than that of GAD-Ab on islet β-cell function in LADA patients. The value of CPH-Ab for the fa

关 键 词：羧基肽酶-H抗体 谷氨酸脱羧酶抗体 成人隐匿性自身免疫糖尿病 胰岛Β细胞功能 

分 类 号：R587.1[医药卫生—内分泌]