不同类型糖尿病患者21羟化酶抗体的分布研究  

Distribution of 21 hydroxylase antibody in different types of diabetes mellitus

作　　者：任亚萍[1] 黄干[2,3] 杨一芬[1] REN Ya-ping;HUANG Gan;YANG Yi-fen(Department of Laboratory Medicine,the Second Xiangya Hospital,Central South University,Changsha 410011,China;不详)

机构地区：[1]中南大学湘雅二医院检验科,湖南长沙410011 [2]中南大学湘雅二医院代谢内分泌科,湖南长沙410011 [3]中南大学糖尿病免疫学教育部重点实验室,湖南长沙410011

出　　处：《中国实用内科杂志》2022年第7期563-567,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家重点研发计划(2018YFC1315601)。

摘　　要：目的 研究不同类型糖尿病患者胰岛自身抗体和21羟化酶抗体(21-OHA)分布情况,为筛查自身免疫性原发性肾上腺皮质功能减退症(Addison病)提供依据。方法 收集2016年至2018年间中南大学湘雅二医院门诊及住院患者,其中1型糖尿病(T1DM)患者179例,2型糖尿病(T2DM)患者198例,妊娠糖尿病(GDM)患者154例以及健康对照200例。采用国际标准放射配体法检测21-OHA以及谷氨酸脱羧酶抗体(GADA)、蛋白酪氨酸磷酸酶抗体(IA-2A)和锌转运体8自身抗体(ZnT8A)等胰岛自身抗体,研究其相互关联以及与临床特征的关系。结果 T1DM组GADA、IA-2A、ZnT8A和21-OHA的阳性率分别为63.7%(114/179)、37.4%(67/179)、33.5%(60/179)和3.9%(7/179),显著高于健康对照组的0.5%(1/200)、0、0和0(P值分别为<0.0001、<0.0001、<0.0001和0.005),同时也显著高于T2DM组的6.1%(12/198)、2.0%(4/198)、2.0%(4/198)和0(P值分别为<0.0001、<0.0001、<0.0001和0.005),以及高于GDM组的3.2%(5/154)、0.6%(1/154)、0.6%(1/154)和0(P值分别为<0.0001、<0.0001、<0.0001和0.013)。7例21-OHA阳性的T1DM患者中,4例存在于双胰岛自身抗体阳性组,1例存在于单胰岛自身抗体阳性组,差异无统计学意义(P=0.058)。综合肾上腺皮质功能检查以及其他临床指证,7例21-OHA阳性的T1DM患者中,1例考虑为合并自身免疫性Addison病。结论 T1DM患者易合并21-OHA阳性,对于特别是多抗体阳性的T1DM患者,筛查21-OHA对于及早识别自身免疫性Addison病有着重要的临床意义。Objective To investigate distribution of 21 hydroxylase antibody(21-OHA)in different types of diabetes mellitus,and to provide basis for screening autoimmune Addison disease early.Methods One hundred and seventy-in the Second Xiangya Hospital nine patients with type 1 diabetes mellitus(T1DM),198 patients with type 2 diabetes mellitus(T2DM),154 patients with gestational diabetes mellitus(GDM),and 200 healthy subjects were included between 2016and 2018.Radioligand binding assays were applied to detect the presence of glutamic acid decarboxylase antibody(GADA),insulinoma-associated protein-2 antibody(IA-2A),zinc transporter 8 autoantibody(ZnT8A)and 21-OHA.In antibody-positive patients,we further examined the function of adrenal cortex,the relationship between 21-OHA and clinical characteristics.Results The prevalence of GADA,IA-2A,ZnT8A and 21-OHA were 63.7%(114/179),37.4%(67/179),33.5%(60/179)and 3.9%(7/179),respectively,which were much higher than those in healthy control[0.5%(1/200),0,0 and 0,P=0.0000,0.0000,0.0000 and 0.005,respectively]or higher than those in T2DM[6.1%(12/198),2.0%(4/198),2.0%(4/198)and 0,P<0.0001,P<0.0001,P<0.0001 and P=0.005,respectively],or higher than those in GDM[3.2%(5/154),0.6%(1/154),0.6%(1/154)and 0(P<0.0001、P<0.0001、P<0.0001) and P=0.013,respectively].Of the seven 21-OHA positive T1DM patients,4 cases were positive for two islet autoantibodies(57.1%),and 1 case was positive for one islet autoantibody(14.3%).Further adrenocortical function and clinical analysis showed that one case of the seven 21-OHA positive T1DM patients was diagnosed as autoimmune Addison disease.Conclusion T1DM usually occurs together with 21-OHA,the measurement of 21-OHA will be beneficial to distinguish autoimmune Addison disease in T1DM patients early.

关 键 词：1型糖尿病 2型糖尿病 妊娠糖尿病 21-羟化酶抗体 胰岛自身抗体 

分 类 号：R587.1[医药卫生—内分泌]