四种胰岛自身抗体诊断成人隐匿性自身免疫性糖尿病的临床意义_杨琳

・成人隐匿性自身免疫性糖尿病・

基金项目:国家自然科学基金项目(30400217);湖南省卫生厅重点项目(9736,20012Z04);湖南省科技厅重点项目

(03SSY1009);美国礼来亚洲公司科研基金资助项目(7282/B5K 2GH 20435)

作者单位:410011长沙,中南大学湘雅二医院内分泌科,代谢内分泌研究所通讯作者:周智广,Email:zhouzg@hot m ail .com

四种胰岛自身抗体诊断成人隐匿性自身免疫

性糖尿病的临床意义

杨琳　周智广　黄干　金萍　亓海英　李霞　陈小燕

【摘要】　目的　探讨应用4种胰岛自身抗体[谷氨酸脱羧酶抗体(G AD 2Ab )、羧基肽酶H 抗体(CPH 2Ab )、蛋白酪氨酸磷酸酶抗体(I A 22Ab )、胰岛素自身抗体(I A A )]诊断成人隐匿性自身免疫性糖尿病(LADA )的策略。方法　选择临床2型糖尿病(DM )患者1296例,1型DM 患者110例,健康对照205名。

用35S 2甲硫氨酸标记重组人羧基肽酶H (CPH )和谷氨酸脱羧酶(G AD 65),采用放射配体法检测所有患者血清的CPH 2Ab 和G AD 2Ab;其中545例还检测蛋白酪氨酸磷酸酶抗体(I A 22Ab ),98例检测胰岛素自身抗体

(I A A ),均采用放射配体法检测。结果　临床2型DM 患者的G AD 2Ab 阳性率9.0%(117/1296)高于CPH 2Ab 4.8%(62/1296,P <0.01),二者均高于健康对照(P <0.01和0.05);I A 22Ab 和I A A 频率分别为1.3%(7/545)和0%(0/98),低于CPH 2Ab (P <0.01)。在2型DM 患者中I A 22Ab 与G AD 2Ab 的重叠率

为57.1%(4/7),高于CPH 2Ab 8.1%(5/62,P <0.01)。G AD 2Ab 和CPH 2Ab 联合检测阳性率达15.0%(82/

545),与三抗体联合(G AD 2Ab +CPH 2Ab +I A 22Ab )检测15.6%(85/545)差异无统计学意义(P >0.05),而

显著高于G AD 2Ab 联合I A 22Ab 或CPH 2Ab 联合I A 22Ab 检测阳性率(比10.3%和比6.6%,均P <0.01)。结论　单一抗体诊断LADA 的敏感性为G AD 2Ab >CPH 2Ab >I A 22Ab >I A A 。临床筛查LADA 以联合检测

G AD 2Ab 和CPH 2Ab 的效率最佳。采用I A 22Ab 和I A A 诊断LADA 的效率低,临床可考虑不予常规检测。

【关键词】　成人隐匿性自身免疫性糖尿病;诊断;谷氨酸脱羧酶杭体;羧基肽酶H 抗体;蛋白酪氨酸磷酸酶抗体;胰岛素自身抗体

The eff i cacy of 4islet autoan ti bod i es i n the d i a gnosis of l a ten t auto i m m une d i a betes i n adults Y AN G L in,ZHOU Zhi 2guang,HUAN G Gan,J I N Ping,Q I Hai 2ying,L i X ia,CHEN X iao 2yan .Institute of M etabolis m and Endocrinology,Second X iangya Hospital,Central South U niversity,Changsha 410011Corresponding author :ZHOU Zhi 2guang,Em ail:zhouzg @hot m ail .co m

【Abstract 】　O bjecti ve To exp l ore the diagnostic strategies of latent aut oi m mune diabetes in adults (LADA )with f our kinds of islet aut oantibodies .M ethods A t otal of 1296patients with type 2diabetes mellitus (DM ),110type 1DM patients and 205healthy contr ols were recruited .Recombinant hu man carboxypep tidase 2H

(CPH )and gluta m ic acid decarboxylase (G AD 65)were labeled with 35

S 2methi onine and used t o evaluate aut oantibodies t o CPH (CPH 2Ab )and G AD (G AD 2Ab )in all the patients by radi oligand assay (RLA ).I n additi on,p r otein tyr osine phos phatase antibody (I A 22Ab )and insulin aut oantibody (I A A )were assayed by RLA in 545and 98type 2DM patients res pectively .Results I n type 2DM patients 9.0%(117/1296)were positive for G AD 2Ab,being significantly higher than 4.8%(62/1296)f or CPH 2Ab (P <0.01),both resultswere higher than those of healthy contr ols (P <0.05or 0.01res pectively ).The p revalences of I A 22Ab and I A A were 1.3%(7/545)and 0%(0/98)res pectively,both being l ower than that of CPH 2Ab (P <0.01).The overlapp ing positive rate bet w een I A 22Ab and G AD 2Ab was 57.1%(4/7),being higher than that bet w een I A 22Ab and CPH 2Ab of 8.1%(5/62)(P <0.01).The combined positiveness of G AD 2Ab and CPH 2Ab were 15.0%(82/545),being not significantly different with that of G AD 2Ab,CPH 2Ab and I A 22Ab combined 15.6%(85/545,P >0.05),but significantly higher than that of G AD 2Ab and I A 22Ab or CPH 2Ab and I A 22Ab combined (vs 10.3%&6.6%,both P <0.01).Conclusi on The diagnostic sensitivity f or LADA with single antibody is as f oll owed:G AD 2Ab >CPH 2Ab >I A 22Ab >I A bined analysis of G AD 2Ab and CPH 2Ab is the most effective way for screening LADA patients .I A 22Ab and I A A are not recommended f or r outine screening as they have l ow diagnostic efficacy f or LADA.