ICA、ZnT8A、GADA联合检测对重庆儿童1型糖尿病早期诊断的意义  

Significance of combined determination of ICA,ZnT8A and GADA in early diagnosis of type 1 diabetes mellitus in Chongqing

作　　者：李小强[1] 谢婧雯[1] 吉颖[1] 陈琼[1] 李伶[2] Li Xiaoqiang Xie Jingwen Ji Ying Chen Qiong Li Ling(Department of Clinical Laboratory,the Children ＇s Hospital,Chongqing Medical University Key Laboratory of Clinical Laboratory Diagnostics Founded by Ministry of Education,College of Laboratory Medicine,Chongqing Medical University)

机构地区：[1]重庆医科大学附属儿童医院检验科,重庆400014 [2]重庆医科大学检验医学院教育部临床检验诊断学重点实验室,重庆400010

出　　处：《重庆医科大学学报》2017年第5期546-549,共4页Journal of Chongqing Medical University

基　　金：国家自然科学基金面上资助项目(编号:81570752);重庆市卫计委资助项目(编号:渝卫科教2013-2-048)

摘　　要：目的:通过观察研究重庆地区1型糖尿病(type 1 diabetes mellitus,T1DM)儿童患者血清中胰岛细胞抗体(islet cell antibodies,ICA)、锌转运体8自身抗体(zinc transporter isoform 8 autoantibodies,Zn T8A)和胰岛相关自身抗体谷氨酸脱羧酶抗体(glutamic acid decarboxylase antibodies,GADA)的阳性率及其空腹C肽结果,探讨ICA、Zn T8A和GADA联合检测对1型糖尿病早期诊断的价值。方法:在我院初诊的T1DM组139例和正常组78例儿童,采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测ICA、Zn T8A和GADA;放射免疫法测定空腹C肽。T1DM组按自身抗体结果分为阳性组和阴性组。结果:1型糖尿病组的血清ICA、Zn T8A和GADA阳性率分别为61.9%(P=0.000)、51.1%(P=0.000)和54.0%(P=0.000),均明显高于正常对照组;抗体联合检测组的诊断符合率(ICA/Zn T8A=80.6%;ICA/GADA=81.6%;Zn T8A/GADA=78.3%;ICA/Zn T8A/GADA=88.9%)均高于单项抗体检测组,抗体联合检测与任一抗体单项检测的ROC曲线下面积相比均明显增大(P<0.05),3种抗体联合检测AUC=0.883(95%CI=0.830~0.936,P=0.000);抗体阳性患者的空腹C肽水平明显低于抗体阴性患者。结论:ICA、Zn T8A和GADA三者联合检测可以明显提高1型糖尿病的诊断效能。Objective：To evaluate the significance of combined determination of islet cell antibodies（ICA）,zinc transporter isoform 8autoantibodies（Zn T8A）and glutamic acid decarboxylase antibodies（GADA）in precaution of type 1 diabetes mellitus in children in Chongqing by investigating the positive rate of ICA,Zn T8 A,GADA and C peptide. Methods：Totally 139 children with newly diagnosed type 1 diabetes（T1DM group）and 78 age-matched healthy controls（control group）were studied. ICA,Zn T8 A and GADA were determined by enzyme-linked immunosorbent assay and C peptide by radioimmunoassay. T1 DM group was divided into positive group and negative group according to autoantibody. Results：Compared with those of normal subjects,the positive rates of ICA,Zn T8 A and GADA were significantly elevated in patients with type 1 diabetes mellitus（61.9%,P=0.000;51.1%,P=0.000;54.0%,P=0.000）. The diagnostic accordance rate of combined determination of autoantibodies（ICA/Zn T8A=80.6%,ICA/GADA=81.6%,Zn T8A/GADA=78.3%,ICA/Zn T8A/GADA=88.9%）is higher than a single detection. The area under the ROC curve of combined determination of autoantibodies is larger than a single detection（P〈0.05）,AUC for ICA/Zn T8A/GADA is 0.883（95%CI=0.830 to 0.936,P=0.000）. Fasting C peptide levels of antibody positive diabetes were significantly lower than those of antibody negative diabetes（P〈0.05）. Conclusion：The efficiency of diagnosis of type 1 diabetes mellitus can be significantly approved by combined determination of ICA,Zn T8 A and GADA.

关 键 词：1型糖尿病 胰岛细胞抗体 锌转运体8自身抗体 谷氨酸脱羧酶抗体 自身抗体联合检测 

分 类 号：R446.1[医药卫生—诊断学]