GADA、ICA和IAA联合检测对1型糖尿病的诊断价值  

Diagnostic values of combining detection of GADA、ICA and IAA in type 1 diabetes mellitus

作　　者：刘锐[1] 郑岚[2] 何成彦[2] 刘波[1] 

机构地区：[1]吉林大学中日联谊医院内分泌科,吉林长春130033 [2]吉林大学中日联谊医院检验科,吉林长春130033

出　　处：《中国实验诊断学》2010年第3期402-405,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的通过观察1型糖尿病患者血清谷氨酸脱羧酶抗体(GADA)、胰岛细胞抗体(ICA)、胰岛素自身抗体(IAA)的测定结果及其空腹C肽(FCP)和餐后2小时C肽(CP2h)的测定结果,探讨GADA、ICA和IAA联合检测对1型糖尿病的诊断价值。方法采用酶联免疫吸附法(ELISA)检测GADA、ICA和IAA;放射免疫法测定空腹C肽和餐后2小时C肽。结果1型糖尿病患者的GADA、ICA和IAA分别为62.2%、41.5%和37.8%,显著高于2型糖尿病组和正常对照组(P<0.01),其中GADA阳性率显著高于ICA和IAA(P<0.01)。抗体阳性患者的空腹和餐后C肽水平明显低于抗体阴性患者(P<0.01)。青少年组患者ICA阳性率高于GADA和IAA(P<0.01),并且联合检测GADA/ICA和IAA三种抗体检测的阳性率明显高于单一抗体检测的阳性率。成年组及老年组患者GADA阳性率高于ICA和IAA(P<0.01)。3种自身抗体联合检测的敏感性、特异性、阳性预报率、阴性预报率和诊断符合率分别为87.8%、85.7%、93.5%、75.0%和87.2%。结论自身抗体阳性患者可能存在明显的胰岛功能损伤;GADA、ICA和IAA联合检测可以提高诊断敏感性和诊断符合率,并且对1型糖尿病与2型糖尿病的鉴别有重要意义。青少年期患者GADA和ICA组合或GADA、ICA和ICC的联合检测有更大的意义。Objective To investigate the clinical significance of combined determination of glutamic acid decarboxylase antibod- ies （GADA）, islet cell antibodies （ICA） and insulin autoantibodics（IAA） in type 1 diabetes mellitus, by obserbing results of GADA, ICA, IAA and C peptide. Methods GADA, ICA and IAA were determined by enzyme-linked immunosorbent assay and C peptide by radioimmunoassay. Results the positive rate of GADA, ICA and IAA （62.2 %, 41.5 % and 37.8 % ） were significantly elevated in the patients with type 1 diabetes mellitus compared with type 2 diabetes mellitus or normal subjects （ P 〈 0. 01 ）, and positive rate of GADA was higher than that of ICA and IAA （ P 〈 0.01）. Fasting and postprandial C peptide levels of antibody positive diabetes were significantly lower than those of antibody negative diabetes （ P 〈 0.01 ）. The positive rate of ICA in juvenile patients with diabetes, was higher than that of GADA and IAA （ P 〈 0. 001 ）, while in adult patients with diabetes, the positive rate of GADA was higher than that of ICA and IAA （ P 〈 0.05） . Sensitivity, specificity, positive prediction rate, negative prediction rate and diagnostic accuracy rate of combined detection for three antoantibodies is 87.8 %, 85.7 % , 93.5 % ,75.0 % and 37.8 %. Conclusion The beta-cell function of type 1 diabetes mellitus patients with positive autoantibodies may be significantly damaged; Combined determination of three autoanti- bodies may approve the sensitivity and accuracy of diagnosis, and GADA , ICA and IAA were important immunological markers to identify the diabetes mellitus type 1 and type 2. It is more important to combined detect GADA and ICA or three autoantibodies for adolescent patients with type 1 diabetes.

关 键 词：糖尿病 谷氨酸脱羧酶抗体 胰岛细胞抗体 胰岛素自身抗体 

分 类 号：R587.1[医药卫生—内分泌]