3种自身抗体联合生化指标检测在2型糖尿病患者的临床意义  

Clinical significance of detection of three autoantibodies combined with biochemical markers in serum of patients with type 2 diabetes

作　　者：张培莉[1] 邹建文[1] 邵婧[1] 陈兰兰[1] 王景鸿[1] 牛登冉 ZHANG Peili;ZOU Jianwen;SHAO Jing;CHEN Lanlan;WANG Jinghong;NIU Dengran(Department of Clinical Laboratory,Shandong Provincial Hospital Affiliated to Shandong University,Ji′nan,Shandong 250021,China)

机构地区：[1]山东大学附属省立医院临床医学检验部

出　　处：《国际检验医学杂志》2019年第24期3007-3009,3013,共4页International Journal of Laboratory Medicine

基　　金：山东省自然科学基金项目（ZR2016HM52、ZR2017BH074）;济南市科技计划项目（201704103）

摘　　要：目的探讨2型糖尿病患者中血清谷氨酸脱羧酶抗体(GADA)、抗胰岛素抗体(IAA)、抗胰岛细胞抗体(ICA)和生化指标检测的临床意义及成人隐匿性自身免疫性糖尿病(LADA)比例。方法对107例2型糖尿病患者和50例健康对照者进行3种自身抗体、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、糖化清蛋白(GA)、空腹胰岛素(INS)、空腹C肽进行检测,结合临床诊断出其中的LADA患者,对上述检测指标进行比较分析。结果GADA、IAA、ICA在2型糖尿病患者检测的阳性率分别为15.88%、17.75%、3.73%;联合检测阳性率为28.03%,高于健康对照组和单一抗体患者。自身抗体阳性组和阴性组比较,HbA1c、GA、空腹C肽水平比较,差异有统计学意义(P<0.05)。107例2型糖尿病患者中确诊11例LADA患者,LADA患者HbA1c、GA水平高于非LADA 2型糖尿病患者,C肽水平低于非LADA 2型糖尿病患者,差异均有统计学意义(P<0.05)。结论在2型糖尿病患者中检测胰岛自身抗体对检出其中的LADA有重要指导价值,联合生化指标连续监测有利于对疾病鉴别诊断,从而尽快采取措施保护胰岛β细胞功能,减少进一步损伤。Objective To investigate the clinical significance of serum glutamate decarboxylase antibody(GADA),anti-insulin antibody(IAA),anti-islet antibody(ICA)and biochemical markers in patients with type 2 diabetes mellitus(T2DM)and the proportion of latent autoimmune diabetes in adults(LADA).Methods Three autoantibodies,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),glycated albumin(GA),fasting insulin(INS)and fasting C peptide were detected in 107 patients with type 2 diabetes and 50 normal controls.Combined with the clinical diagnosis of LADA patients,the above detection indicators were compared and analyzed.Results The positive rates of GADA,IAA and ICA in T2DM patients were 15.88%,17.75%and 3.73%,respectively.The positive rate of combined detection was 28.03%,which was higher than that of normal control group and single antibody group.There were significant differences in the levels of glycated hemoglobin,glycated albumin and fasting C peptide between the autoantibody positive group and the negative group(P<0.05).Among 107 patients with T2DM,11 patients with LADA were diagnosed.The levels of glycated hemoglobin and glycated albumin in LADA patients were higher than those in non-LADA T2DM patients.The C-peptide level was lower than that in non-LADA T2DM patients,the differences were statistically significant(P<0.05).Conclusion The detection of islet autoantibodies in patients with type 2 diabetes has important guiding value for the detection of LADA.The continuous monitoring of combined biochemical indicators is beneficial to the differential diagnosis of diseases,so as to take measures to protect isletβ-cell function and reduce further damage as soon as possible.

关 键 词：胰岛自身抗体 2型糖尿病 成人隐匿性自身免疫性糖尿病 谷氨酸脱羧酶抗体 

分 类 号：R587.1[医药卫生—内分泌]