【摘要】 目的　研究胰岛自身抗体与糖尿病 (DM)临床表现、β细胞功能的关系。 方法　分析 733例住院DM患者的临床和生化特征 ,测定血清C肽、胰岛细胞抗体 (ICA)、谷氨酸脱羧酶抗体 (GADA)和蛋白酪氨酸磷酸酶抗体 (IA 2A)水平。结果　 58例速发型 1型DM中 34 .5 %GADA阳性 ,2 2 .4%ICA阳性 ,2 7.3 %IA 2A阳性。在临床初诊为 2型DM的 675例患者中 ,1 3 .5 %有一种以上抗体阳性 ,其中 1 0 .1 %GADA阳性 ,2 .7%ICA阳性 ,8.7%IA 2A阳性。在不同病程的成人隐匿性自身免疫性糖尿病 (LADA)中自身抗体阳性率无明显变化 ,而病程 2年以上的 1型DM患者中则呈降低趋势。随着病程延长 ,患者均有空腹和餐后C肽水平降低 ,但下降的速度以 1型DM最快 ,LADA次之 ,2型DM最慢。多因素逐步回归分析表明 ,GADA是导致空腹与餐后C肽水平降低的危险因素。结论　在速发型 1型DM和LADA患者中GADA、ICA和IA 2A阳性率不同 ,联合抗体检测有助于诊断。LADA患者 β细胞功能衰退较慢 ,保护残存β细胞可有利于延缓病情进展更多还原

【Abstract】 Objective To in ve stigate islet autoantibodies in relation to clinical characteristics and islet β cell function in patients with diabetes. Methods Using cohort study, the general clinical and biochemical characteristics w ere investigated in 733 hospitalized diabetic patients. Serum C peptide and seru m antibodies to islet cell cytoplasmic antigens (ICA), glutamic acid decarboxyla se (GADA) and protein tyrosine phosphatase (IA-2A) were determined by immunoflu orescence method or commercial kits. Results Tw enty cases (34.5%) showed positive serum GADA and 13 cases (22.4%) positive ICA in 58 patients with acute onset and ketoacidosis, who were diagnosed as type 1 d iabetes. Serum IA-2A was determined in 22 of these 58 patients and 6 (27.3%) ca ses showed positive results: among 675 patients diagnosed as type 2 diabetes, 91 cases (13.5%) showed at least one antibody positive, 68 (10.1%) were found GADA positive and 18 (2.7%) ICA positive and 23 (8.7%) IA-2A positive (263 sera wer e tested). According to positive or negative serum antibodies and types of onset of the disease, the patients were divided into three groups, type 1 diabetes (w ith acute onset), latent autoimmune diabetes in adults (LADA) and type 2 diabete s. The prevalences of autoantibodies were almost the same in LADA patients with different durations of diabetes. However, the prevalence became lower in type 1 diabetes patients after 2 years. Fasting and postprandial C peptide levels fell gradually with advancing course of the disease. The falling speed was the fastes t in type 1 diabetes patients and the slowest in type 2 diabetes patients among the three groups. Stepwise regression analysis showed that GADA was a risk facto r for declining of fasting and postprandial C peptide levels. Co nclusion There are differences in autoantibody prevalences amon g type 1 diabetes, LADA and type 2 diabetes patients. Combined detection of the autoantibodies would be helpful for diagnosis. LADA patients have slow β cell d estruction and show higher serum C peptide levels even many years after diagnosi s of diabetes, and protecting their residual β cells might slow down the progre ssion of diabetes.更多还原