【摘要】 目的分析不同种类、不同数量胰岛自身抗体阳性的1型糖尿病(T1DM)患者临床特征及胰岛功能。方法收集患者一般信息,行标准馒头餐试验(MMTT)、酶联免疫吸附试验(ELISA)检测胰岛细胞抗体(ICA)、胰岛素抗体(IAA)、谷氨酸脱羧酶抗体(GADA)和蛋白酪氨酸磷酸酶抗体(IA-2A),用SPSS 22.0软件对不同胰岛自身抗体阳性患者的临床特征及胰岛功能进行分析。结果 (1)本试验共纳入T1DM患者572例(男322例,女250例),平均年龄36岁(4~84岁)。四种胰岛自身抗体的阳性率分别为GADA 57%(326/572),IA-2A 27.4%(157/572),ICA18.4%(105/572),IAA 23.3%(13/572),且GADA阳性率显著高于其他三种抗体(P<0.05)。(2)联合检测GADA、ICA、IA-2A三种抗体,抗体阳性数目越多,BMI越小,病程越短,糖化血红蛋白越高,空腹及餐后120 min C肽越低,C肽曲线下面积(AUC)越小,各组间差异均存在统计学意义(P<0.05)。(3)空腹C肽在单一IA-2A阳性组最低,餐后120 min C肽、AUC在单一ICA阳性组最低,但三个单一抗体阳性组间差异无统计学意义(P>0.05);病程、年龄及BMI在IA-2A阳性组最低,三个单一抗体阳性组差异无统计学意义(P>0.05)。(4)GADA+IA-2A双阳性组空腹及餐后120 min C肽、AUC均最低,年龄、病程、BMI较低,与抗体阴性组差异有统计学意义,但与GADA+ICA阳性及ICA+IA-2A阳性组差异无统计学意义(P>0.05)。结论抗体阳性数目越多,病程越短,胰岛功能越差;单独或合并不同抗体阳性的患者临床特征和胰岛功能分析对临床早期干预有指导意义。更多还原

【Abstract】 Objective To observe the change of clinical characteristics and islet function in different autoantibody positive patients with type 1 diabetes.Methods We collected the general information and laboratory test,and measured the level of islet autoantibodies by enzyme-linked immunosorbent assay(ELISA).The subjects were subdivided into different groups according to antibodies test results.Statistical analysis software(SPSS 22.0) was employed to evaluate clinical characteristics and islet function according to the patients with different levels of positive-autoantibody.Results(1) Among 572 patients(322 males and 250 females),the average age was 36 year-old.57% of patients were positive for glutamic acid decarboxylase antibody(GADA),27.4% for protein tyrosine phosphatase antibody(IA-2A),18.4% for islet cell antibody(ICA) and 23.3% for insulin autoantibody(IAA),and positive rate of GADA was higher than that of ICA and IA-2A.(2) Combined detection of GADA,ICA,IA-2A,the smaller the BMI,the shorter the course of disease,the higher the Hb A1 c,the lower the C peptide of fasting and 120 minutes postprandial,the smaller the area under the C-peptide curve with the increase in the number of antibody-positive.(3) Fasting C-peptide was the lowest in IA-2A-positive group and 120 min postprandial C-peptide and AUC was the lowest in ICA-positive group,but no significant difference among three single antibody positive groups was found.There were no significant differences in diseaseduration,age and BMI among the three single antibody positive groups.(4) In combination of two arbitrary antibodies,GADA+ and IA-2A+ group had the lowest fasting,120 min postprandial C peptide and AUC as well as the relatively lower disease duration,age and BMI,but no significant difference was found in three groups.Conclusions The more the number of antibody positive,the shorter the course,the worse the islet function.The analysis on clinical characteristics and islet function of T1 DM patients,which are different from antibody positive alone or in combination,may be useful for clinical early intervention.更多还原