蛋白酪氨酸磷酸酶抗体对成人隐匿性自身免疫性糖尿病的诊断价值  

The diagnostic value of protein tyrosine phosphatase antibody for latent autoimmune diabetes in adults

作　　者：唐炜立[1] 杨非柯[1] 黄干[1] 侯粲[1] 杨琳[1] 李霞[1] 罗说明[1] 潘玲玲[1] 张贻宇[1] 周智广[1] 

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

出　　处：《中国糖尿病杂志》2009年第9期654-657,671,共5页Chinese Journal of Diabetes

基　　金：国家863项目(编号2006AA02A409);湖南省卫生厅重点项目(编号A2004-004)

摘　　要：目的探讨蛋白酪氨酸磷酸酶抗体(IA-2A)对成人隐匿性自身免疫性糖尿病(LADA)的诊断价值。方法采用放射配体法检测2 027例初诊2型糖尿病(T2DM)患者的IA-2A和谷氨酸脱羧酶抗体(GAD-Ab),分析IA-2A在初诊T2DM患者中的分布及其与临床特征的关系。结果初诊T2DM患者中IA-2A阳性检出率低于GAD-Ab阳性检出率(2.2% vs 10.6%,P<0.01)。联合GAD-Ab和IA2A检测,可使LADA阳性检出率达11.5%。IA-2A在低体重、低C肽水平患者中阳性检出率高;随着起病年龄增大,IA-2A阳性检出率下降(P<0.05)。与T2DM组比较,单独IA-2A阳性患者使用胰岛素治疗的比例高(P<0.05)。高滴度IA-2A阳性LADA患者具有起病年龄小(P<0.01)、体重轻、高血压比例低、空腹C肽低、合并GAD-Ab阳性和使用胰岛素比例高(P<0.05)等特点。结论 IA-2A检测对LADA具有辅助诊断价值,与GAD-Ab联合检测可提高LADA诊断的敏感性。Objective To explore the diagnostic value of protein tyrosine phosphatase antibody （IA- 2A） for latent autoimmune diabetes in adults （LADA）. Methods Radioligand assay was used to test IA- 2A and glutamic aeid decarboxylase antibody（GAD-Ab）in 2 027 patients with newly diagnosed phenotypie type 2 diabetes mellitus （T2DM）. The relationship of IA-2A with clinical features was analyzed. Results The positive rate of IA-2A was lower than that of GAD-Ab in the patients with newly diagnosed T2DM （2.2% vs 10. 6%, P〈0. 01）. Combined measurement of GAD-Ab and IA-2A could achieve the detection rate of LADA to 11.5%. The detection rate of IA-2A was higher in the group with low body weight and low C-peptide and declined with the increasing of age at onset （P〈0. 05）. Compared with T2DM patients, isolated IA-2A positive patients were more prone to insulin therapy （P〈0. 05）. The characteristics of LADA patients with high-titer positive IA-2A were as follows., younger age at onset （P〈0.01）, lower body mass index, lower fasting C-peptide, lower proportion of hypertension, and higher ratio of positive GAD-Ab and insulin therapy （P〈0.05）. Conclusions IA-2A testing is useful for identifying LADA from T2DM. Joint detection of GAD-Ab and IA-2A can improve the diagnostic sensitivity for LADA.

关 键 词：糖尿病 2型 蛋白酪氨酸磷酸酶抗体 糖尿病 成人隐匿性自身免疫性 

分 类 号：R587.1[医药卫生—内分泌] R735.7[医药卫生—内科学]