锌转运体8自身抗体对急性起病糖尿病患者分型诊断的价值  

Value of zinc transporter 8 antoantibody in the diagnostic classification of acute-onset diabetics

作　　者：杨琳[1] 罗说明[1] 黄干[1] 彭健[1] 颜湘[1] Janet Wenzlau Howard W Davidson John C Hutton 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代谢内分泌研究所中南大学糖尿病中心,长沙410011 [2]PO Box 6511, 1775 Ursul a Court, Aurora, CO 80045, Barbara Davis Center for Childhood Diabetes, University of Colorado at Denver and Health Sciences Center, USA

出　　处：《中华医学杂志》2010年第36期2536-2540,共5页National Medical Journal of China

基　　金：基金项目：国家自然科学基金（30670991、30400217）;教育部博士点基金（200805330055）

摘　　要：目的 探讨锌转运体8自身抗体（ZnT8A）对急性起病糖尿病患者分型诊断的价值.方法 453例急性起病糖尿病患者根据谷氨酸脱羧酶抗体（GADA）和酪氨酸磷酸酶抗体（IA2-A）阳性分为A＋组276例（任一抗体阳性）和A-组177例（抗体皆为阴性） 将555例2型糖尿病患者和405名健康者作为对照.分析ZnT8A在急性起病糖尿病患者和亚组中的分布规律、相关因素和ZnT8A阳性者的临床特征.抗体检测采用放射配体法.结果 （1）ZnT8A在急性起病糖尿病组的阳性率为24.3%,显著高于2型糖尿病组（1.8%）和健康对照组（1.0%）（均P＜0.01） 而且ZnT8A在A＋组中的检出率为29.7%,显著高于A-组患者15.8%（x2=11.318,P＜0.01）.（2）ZnT8A阳性率在＜30岁各亚组高于≥30岁亚组（0～9岁,34.9% 10～19岁,26.7% 20～29岁,26.3%比≥30岁,18.3% 均P＜0.05） 在体质指数（BMI）＜21.0 kg/m2和21.0～25.0 kg/m2亚组高于BMI＞25.0 kg/m2亚组（25.5%和25.9%比8.7%,均P＜0.05）.（3）ZnT8A水平与IA2-A滴度间呈正相关（r=0.165,P=0.01）.（4）3种抗体联合测定使自身免疫检出率从60.9%提高到67.1%.（5）与抗体阴性者相比,ZnT8A单独阳性者日胰岛素需要量较多[（35.5±9.3）U/d比（29.8±14.7）U/d,P＜0.05],而收缩压和舒张压均较低[（107±15）mm Hg比（113±16）mm Hg,（69±12）mm Hg比（73±12）mm Hg,均P＜0.05].结论 ZnT8A对急性起病糖尿病患者的免疫分型诊断有一定价值,在常见抗体（GADA和IA2-A）阴性者中可识别出一类更接近于经典1型糖尿病的临床表型.Objective To explore the application significance of zinc transporter 8 autoantibody （ZnT8A） in the diagnostic classification of acute-onset diabetics. Methods According to the status of glutamic acid decarboxylase antibody（GADA） and tyrosine phosphatase antibody（ IA2-A）, 453 acute-onset diabetics were divided into A ＋ subgroup （ any antibody positive ） and A - subgroup （ both antibodies negative）. A total of 555 type 2 diabetics and 405 healthy controls were recruited. The distribution and correlated factors of ZnT8A were analyzed in the acute-onset diabetic group and two subgroups（ A ＋ and A- ）. The clinical characteristics were compared between the patients with ZnT8A positive alone and patients without any antibody. All these islet antibodies were measured by radioligand assay. Results The prevalence of ZnT8A in acute-onset diabetics was 24.3% and it was significantly higher than that in type 2 diabetics（ 1.8% ） and healthy controls（ 1.0% ） （ both P 〈0.01 ）. The frequency of ZnT8A in A ＋ subgroup was much higher than A - subgroup（29.7% vs 15.8%, P 〈 0.01 ）. The positive rates of ZnT8A were much higher in all the subgroups with age at onset of 〈30yr than those with ≥30yr（0 -9, 34.9% 10 -19, 26.7% 20 -29, 26.3% vs ≥30 yr, 18.3% all P〈0.05） furthermore, the rates were also higher in BMI 〈21.0 kg/m2 and 21.0 -25.0 kg/m2 subgroups than in BMI 〉25.0 kg/m2 subgroup（25.5% and 25.9% vs 8.7%, both P 〈 0.05 ）. The ZnT8A level was only positively correlated with IA2-A titer（ r =0.165, P=0.01）, but not related to such factors as GADA titer, age at onset, duration, body mass index,HbAlc and CP levels（ all P 〉0.05）. As compared with Ab- patients, the patients with ZnT8A positive alone had much higher insulin injection dosage [（ 35.5 ± 9.3 ） U/d vs （ 29.8 ± 14.7 ） U/d, P 〈 0.05], and much lower systolic blood pressures [（ 107 ± 15 ） mm Hg vs （ 113 ± 16 ） mm Hg, P 〈 0.05] and diastolic blood pressures [（69 ± 12）

关 键 词：糖尿病 1型 诊断 ZnT8自身抗体 急性起病 

分 类 号：R686[医药卫生—骨科学]