【摘要】 目的探讨伴与不伴甲状腺自身免疫的1型糖尿病(T1DM)及成人隐匿性自身免疫性糖尿病(LADA)患者GAD65抗原表位反应性的差异。方法对112例T1DM、107例LADA患者采用放射配体法检测分析谷氨酸脱羧酶抗体(GADA)对GAD67、GAD65氨基端(GAD65-N)、GAD65中段(GAD65 M)、GAD65羧基端(GAD65-C)抗原表位反应性,并采用放射免疫法检测甲状腺过氧化物酶抗体(TPO-Ab)、甲状腺球蛋白抗体(TG-Ab)。结果 (1)甲状腺自身抗体阳性的T1DM患者GADA对GAD65-M段、GAD65-C端抗原的识别率均高于甲状腺自身抗体阴性组(48.0% vs16.1%和82.0% vs58.1%,P均<0.05)。(2)与甲状腺自身抗体阴性者相比,甲状腺自身抗体阳性的LADA患者GADA与GAD65-M段、GAD65-C端结合率较高(51.6% vs 23.7%和70.9% vs 38.2%,P 均<0.05)。(3)Logistic回归分析显示,GADA同时识别GAD65-M段及-C端抗原表位是T1DM及LADA患者发生甲状腺自身免疫的危险因素(OR=5.016和4.724,P 均<0.05)。结论 GADA同时识别GAD65-M段及-C端抗原表位的自身免疫糖尿病患者易于发生甲状腺自身免疫紊乱;GAD65抗原表位反应性检测有助于预测T1DM及LADA患者发生甲状腺自身免疫的风险。更多还原

【Abstract】 Objective To compare the epitopes of GAD65 autoantibodies in type 1 diabetes (T1DM) and latent autoimmune diabetes in adults (LADA) patients with versus without thyroid autoimmunity. Methods The glutamic acid decarboxylase antibody (GADA) levels and their relative epitope reactivities to N-terminal (GAD65-N),middle (GAD65-M) and C-terminal (GAD65-C) regions of human GAD65 were determined by radioligand immunoassay in 112 TIDM,107 LADA patients.Thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (TG-Ab) were measured by radioimmunoassay.Results The prevalences of the high titer GADA were higher in TIDM and LADA patients with thyroid autoimmunity than in those without it (62.0% vs 41.9% and 54.8% vs 26.3%,P<0.05).The 46.0% TIDM patients and 51.6% LADA patients with thyroid autoimmunity had antibodies against both GAD65-M and GAD65- C terminal,and the corresponding percents was higher than those without thyroid autoimmunity (14.5% and 18.4%,P< 0.001).Multiple logistic regression revealed that GAD65-M+C-Ab positivity were significantly associated with thyroid autoimmunity in TIDM and LADA patients (OR=5.016 and 4.724, P<0.05).Conclusions T1DM and LADA patients with GAD65-M + C epitope-specific reactivity show an increased risk for thyroid autoimmunity.更多还原