【摘要】 目的探讨应用4种胰岛自身抗体[谷氨酸脱羧酶抗体(GADAb)、羧基肽酶H抗体(CPHAb)、蛋白酪氨酸磷酸酶抗体(IA2Ab)、胰岛素自身抗体(IAA)]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甲硫氨酸标记重组人羧基肽酶H(CPH)和谷氨酸脱羧酶(GAD65),采用放射配体法检测所有患者血清的CPHAb和GADAb;其中545例还检测蛋白酪氨酸磷酸酶抗体(IA2Ab),98例检测胰岛素自身抗体(IAA),均采用放射配体法检测。结果临床2型DM患者的GADAb阳性率9.0%(117/1296)高于CPHAb4.8%(62/1296,P<0.01),二者均高于健康对照(P<0.01和0.05);IA2Ab和IAA频率分别为1.3%(7/545)和0%(0/98),低于CPHAb(P<0.01)。在2型DM患者中IA2Ab与GADAb的重叠率为57.1%(4/7),高于CPHAb8.1%(5/62,P<0.01)。GADAb和CPHAb联合检测阳性率达15.0%(82/545),与三抗体联合(GADAb+CPHAb+IA2Ab)检测15.6%(85/545)差异无统计学意义(P>0.05),而显著高于GADAb联合IA2Ab或CPHAb联合IA2Ab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GADAb>CPHAb>IA2Ab>IAA。临床筛查LADA以联合检测GADAb和CPHAb的效率最佳。采用IA2Ab和IAA诊断LADA的效率低,临床可考虑不予常规检测。更多还原

【Abstract】 Objective To explore the diagnostic strategies of latent autoimmune diabetes in adults (LADA) with four kinds of islet autoantibodies. Methods A total of 1296 patients with type 2 diabetes mellitus (DM), 110 type 1 DM patients and 205 healthy controlswere recruited. Recombinant human carboxypeptidase-H (CPH) and glutamic acid decarboxylase (GAD 65 ) were labeled with ~ 35 S-methionine and used to evaluate autoantibodies to CPH (CPH-Ab) and GAD (GAD-Ab) in all the patients by radioligand assay (RLA). In addition, protein tyrosine phosphatase antibody (IA-2Ab) and insulin autoantibody(IAA) were assayed by RLA in 545 and 98 type 2 DM patients respectively. Results In type 2 DM patients 9.0% (117/1296) were positive for GAD-Ab, being significantly higher than 4.8% (62/1296) for CPH-Ab (P<0.01), both results were higher than those of healthy controls (P<0.05 or 0.01 respectively). The prevalences of IA-2Ab and IAA were 1.3% (7/545) and 0% (0/98) respectively, both being lower than that of CPH-Ab (P<0.01). The overlapping positive rate between IA-2Ab and GAD-Ab was 57.1% (4/7), being higher than that between IA-2Ab and CPH-Ab of 8.1% (5/62) (P<0.01). The combined positiveness of GAD-Ab and CPH-Ab were 15.0% (82/545),beingnotsignificantlydifferentwiththatofGAD-Ab,CPH-Aband IA-2Ab combined 15.6% (85/545, P>0.05), but significantly higher than that of GAD-Ab and IA-2Ab or CPH-Ab and IA-2Ab combined (vs 10.3%& 6.6%, both P<0.01). Conclusion The diagnostic sensitivity for LADA with single antibody is as followed: GAD-Ab> CPH-Ab>IA-2Ab>IAA. Combined analysis of GAD-Ab and CPH-Ab is the most effective way for screening LADA patients. IA-2Ab and IAA are not recommended for routine screening as they have low diagnostic efficacyfor LADA.更多还原