ZnT-8A对成人隐匿性免疫性糖尿病诊断价值的初步研究
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摘要
目的探究锌转运体8自身抗体(Zn T-8A)对成人隐匿性免疫性糖尿病(LADA)的诊断价值。方法回顾性分析2017年5月至2018年4月大理大学第一附属医院收治的160例初诊为糖尿病的患者,根据糖尿病分型将患者分为A组(T1DM非LADA,n=60)、B组(T2DM,n=69)、C组(LADA,n=31)。对比三组常规胰岛自身抗体和Zn T-8A阳性率及联合检测阳性率、三组Zn T-8A阳性率、C组各胰岛自身抗体阳性率。结果 C组患者的血清GADN、IAA、IA-2A、ICA、Zn T-8A抗体阳性率分别为41. 9%、25. 8%、22. 6%、16. 1%、61. 3%,均分别高于A组的11. 7%、6. 7%、10. 0%、6. 7%、13. 3%(P <0. 05)及B组的10. 1%、7. 2%、8. 7%、7. 2%、8. 7%(P <0. 05)。C组患者的ZnT-8A抗体阳性率为61. 3%,分别高于A组的13. 3%、B组的8. 7%(P <0. 05)。C组的ZnT-8A抗体阳性率最高,与其他胰岛自身抗体比较差异具有统计学意义(P <0. 05)。C组5种胰岛自身抗体联合检测阳性率为93. 5%,分别高于A组的23. 3%、B组的18. 8%,三组比较差异均具有统计学意义(P <0. 05)。结论常规胰岛自身抗体联合Zn T-8A抗体检测有助于进一步诊断LADA,且相较于常规抗体,Zn T-8A抗体阳性率更高,对临床后续治疗有重要的指导意义。
Objective To explore the diagnostic significance of zinc transporter 8 autoantibodies( ZnT-8 A) in adults with occult immune diabetes. Methods Retrospective analysis of 160 patients with newly diagnosed diabetes admitted to First Affiliated Hospital of Dali University during May 2017 to April 2018 had been carried,according to the classification of diabetes,they were divided into group A( T1 DM no LADA,n = 60),group B( T2 DM,n = 69),group C( LADA,n = 31),compare these three groups of conventional islet autoantibodies and ZnT-8 A positive rate,positive rate and united detection of ZnT-8 A positive rate,C group each islet autoantibodies in C group were positive. Results The positive rate of serum GADN,IAA,IA-2 A,ICA,ZnT-8 A in group C was 41. 9%,25. 8%,22. 6%,16. 1% and 61. 3%,respectively,higher than that in group A( 11. 7%,6. 7%,10. 0%,6. 7%,13. 3%( P < 0. 05) and that in group B( 10. 1%,7. 2%,8. 7%,7. 2%,8. 7%,8. 7%). The positive rate of ZnT-8 A antibody was 61. 3% in group C,higher than 13. 3% in group A and 8. 7% in group B( P < 0. 05). The positive rate of ZnT-8 A antibody was highest in group C,and the difference was statistically significant compared with other islet autoantibodies( P < 0. 05). The combined positive rate of group C was 93. 5%,which was higher than 23. 3% of group A and 18. 8% of group B,and the difference was statistically significant( P < 0. 05). Conclusion Conventional islet autoantibodies combined with ZnT-8 A antibody test are helpful for further diagnosis of LADA,and the positive rate is the highest compared with conventional antibodies,which is of great significance for clinical follow-up treatment.
Objective To explore the diagnostic significance of zinc transporter 8 autoantibodies( ZnT-8 A) in adults with occult immune diabetes. Methods Retrospective analysis of 160 patients with newly diagnosed diabetes admitted to First Affiliated Hospital of Dali University during May 2017 to April 2018 had been carried,according to the classification of diabetes,they were divided into group A( T1 DM no LADA,n = 60),group B( T2 DM,n = 69),group C( LADA,n = 31),compare these three groups of conventional islet autoantibodies and ZnT-8 A positive rate,positive rate and united detection of ZnT-8 A positive rate,C group each islet autoantibodies in C group were positive. Results The positive rate of serum GADN,IAA,IA-2 A,ICA,ZnT-8 A in group C was 41. 9%,25. 8%,22. 6%,16. 1% and 61. 3%,respectively,higher than that in group A( 11. 7%,6. 7%,10. 0%,6. 7%,13. 3%( P < 0. 05) and that in group B( 10. 1%,7. 2%,8. 7%,7. 2%,8. 7%,8. 7%). The positive rate of ZnT-8 A antibody was 61. 3% in group C,higher than 13. 3% in group A and 8. 7% in group B( P < 0. 05). The positive rate of ZnT-8 A antibody was highest in group C,and the difference was statistically significant compared with other islet autoantibodies( P < 0. 05). The combined positive rate of group C was 93. 5%,which was higher than 23. 3% of group A and 18. 8% of group B,and the difference was statistically significant( P < 0. 05). Conclusion Conventional islet autoantibodies combined with ZnT-8 A antibody test are helpful for further diagnosis of LADA,and the positive rate is the highest compared with conventional antibodies,which is of great significance for clinical follow-up treatment.
引文
[1]金月萍,苏晓飞.成人隐匿性自身免疫性糖尿病诊治的相关研究进展[J].中国糖尿病杂志,2015,23(6):570-573.
[2]李彦青,董自杰,孙晓慧,等.糖尿病自身抗体GADA、IA-2A、ICA、IAA、ZnT-8A对T1DM发病风险的预测价值[J].贵州医药,2018,42(1):22-24.
[3]《中国糖尿病防治指南》编写组.中国糖尿病防治指南[M].北京:北京医科大学出版社,2004:254-256.
[4]罗锐,计海芬.糖尿病患者血清中的自身抗体谱分布及早期诊断的应用研究[J].糖尿病天地,2018,15(3):8-9.
[5]应金奕,沈旭慧.成人隐匿性自身免疫性糖尿病及其机制研究进展[J].现代免疫学,2015,35(4):345-347,298.
[6]卢建强,王伟佳,黄秋洪.胰岛自身抗体及生化指标在成人隐匿性自身免疫性糖尿病诊断中的应用[J].国际检验医学杂志,2018,39(2):238-240.
[7]马昂,王丽宏,车慧,等.成人隐匿性自身免疫糖尿病血清学抗体的诊断意义[J].东南大学学报(医学版),2015,34(5):825-827.
[8]吴敏,杨宏山,黄淑玉.新诊断2型糖尿病患者谷氨酸脱羧酶抗体、胰岛细胞抗体和胰岛素自身抗体联合筛查成人隐匿性自身免疫性糖尿病的意义[J].中国糖尿病杂志,2013,21(11):1018-1020.
[9]邢春燕,曹维,陈家伟,等.1型糖尿病患者中胰岛B细胞特异性锌转运蛋白自身抗体检测标准的建立[J].中国实验诊断学,2010,14(3):349-352.
[10]程丽华,田海容,马佳妮,等.检测自身免疫性糖尿病抗体谱GA-DA,ICA,IA-2A,IAA,ZnT-8A在诊断Ⅰ型糖尿病中的应用价值[J].心理医生,2016,22(19):70-71.
[11]陈晓平,王昕,柳彬彬,等.1型糖尿病患者的临床特点和多种胰岛自身抗体检出情况[J].中华糖尿病杂志,2013,5(6):343-346.
[12]李彦青,赵鸿斌,孙晓慧.化学发光免疫法检测GADA、ICA、Zn T-8A在T1DM诊断中的应用研究[J].河北医药,2017,39(19):2940-2942.
[13]宁翠利,吴孟水.锌转运体8及其自身抗体与糖尿病[J].河北医科大学学报,2017,38(3):363-366.
[14]黄干,孙贵中,杨琳,等.锌转运体8自身抗体和蛋白酪氨酸磷酸酶自身抗体对成人隐匿性自身免疫糖尿病患者胰岛功能的影响[J].中华医学杂志,2015,95(20):1563-1567.
[15]赵鸿斌,祁洁,李彦青.锌转运蛋白8抗体阳性的1型糖尿病患者胰岛自身抗体阳性率及生化指标水平[J].广西医学,2018,40(13):1424-1426,1433.
[2]李彦青,董自杰,孙晓慧,等.糖尿病自身抗体GADA、IA-2A、ICA、IAA、ZnT-8A对T1DM发病风险的预测价值[J].贵州医药,2018,42(1):22-24.
[3]《中国糖尿病防治指南》编写组.中国糖尿病防治指南[M].北京:北京医科大学出版社,2004:254-256.
[4]罗锐,计海芬.糖尿病患者血清中的自身抗体谱分布及早期诊断的应用研究[J].糖尿病天地,2018,15(3):8-9.
[5]应金奕,沈旭慧.成人隐匿性自身免疫性糖尿病及其机制研究进展[J].现代免疫学,2015,35(4):345-347,298.
[6]卢建强,王伟佳,黄秋洪.胰岛自身抗体及生化指标在成人隐匿性自身免疫性糖尿病诊断中的应用[J].国际检验医学杂志,2018,39(2):238-240.
[7]马昂,王丽宏,车慧,等.成人隐匿性自身免疫糖尿病血清学抗体的诊断意义[J].东南大学学报(医学版),2015,34(5):825-827.
[8]吴敏,杨宏山,黄淑玉.新诊断2型糖尿病患者谷氨酸脱羧酶抗体、胰岛细胞抗体和胰岛素自身抗体联合筛查成人隐匿性自身免疫性糖尿病的意义[J].中国糖尿病杂志,2013,21(11):1018-1020.
[9]邢春燕,曹维,陈家伟,等.1型糖尿病患者中胰岛B细胞特异性锌转运蛋白自身抗体检测标准的建立[J].中国实验诊断学,2010,14(3):349-352.
[10]程丽华,田海容,马佳妮,等.检测自身免疫性糖尿病抗体谱GA-DA,ICA,IA-2A,IAA,ZnT-8A在诊断Ⅰ型糖尿病中的应用价值[J].心理医生,2016,22(19):70-71.
[11]陈晓平,王昕,柳彬彬,等.1型糖尿病患者的临床特点和多种胰岛自身抗体检出情况[J].中华糖尿病杂志,2013,5(6):343-346.
[12]李彦青,赵鸿斌,孙晓慧.化学发光免疫法检测GADA、ICA、Zn T-8A在T1DM诊断中的应用研究[J].河北医药,2017,39(19):2940-2942.
[13]宁翠利,吴孟水.锌转运体8及其自身抗体与糖尿病[J].河北医科大学学报,2017,38(3):363-366.
[14]黄干,孙贵中,杨琳,等.锌转运体8自身抗体和蛋白酪氨酸磷酸酶自身抗体对成人隐匿性自身免疫糖尿病患者胰岛功能的影响[J].中华医学杂志,2015,95(20):1563-1567.
[15]赵鸿斌,祁洁,李彦青.锌转运蛋白8抗体阳性的1型糖尿病患者胰岛自身抗体阳性率及生化指标水平[J].广西医学,2018,40(13):1424-1426,1433.