1型糖尿病患者血清胰岛自身抗体阳性率及其与临床指标的相关性
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摘要
目的探讨1型糖尿病(type 1 diabetes mellitus,T1DM)患者血清胰岛自身抗体分布特点、阳性率及其与临床指标的相关性。方法选取2014年1月至2018年12月于北京协和医院内分泌科诊治的100例T1DM患者作为研究对象,对血清中3种胰岛自身抗体——胰岛细胞抗体(islet-cell antibody,ICA)、谷氨酸脱羧酶抗体(glutamic acid decarboxylase antibody,GADA)、蛋白酪氨酸磷酸酶抗体(protein tyrosine phosphatase antibody,IA-2A)水平进行检测,分析3种抗体的分布特点及阳性率,同时根据病程(<1年、1～5年、>5年)、抗体是否阳性及阳性抗体种类(GADA+IA-2A双阳性、GADA单阳性及IA-2A单阳性)对T1DM患者进行分组,比较其临床指标的差异。应用Spearman相关分析探讨各胰岛素自身抗体特征与临床指标之间的关系。结果在3种抗体中,GADA的阳性率(58%)最高,3种抗体联合检测的抗体检出率(74%)明显高于单一抗体(P<0.05)。胰岛自身抗体阳性率、阳性抗体个数随病程延长而下降(P<0.05)。抗体阴性组的血脂水平较抗体阳性组更高(P<0.01)。IA-2A单阳性组的病程较GADA+IA-2A双阳性组、GADA单阳性组更长,但差异无显著性(P>0.05)。结论多种抗体联合检测能提高胰岛自身抗体的检出率,降低T1DM患者尤其是临床不典型T1DM患者的漏诊率。胰岛自身抗体的阳性率随病程延长而下降,与患者的临床特征有一定的关联性。
Objective: To investigate the frequency and distribution of serum islet autoantibodies in patients with type 1 diabetes mellitus(T1DM) and their correlation with clinical features. Method 100 cases of T1DM patients who were diagnosed and treated in the Department of Endocrinology, Peking Union Medical College Hospital from January 2014 to December 2018 were recruited into the study. Serum isletcell antibody(ICA) and glutamic ac id decarboxylase antibody(GADA), protein tyrosine phosphatase antibody(IA-2A) were measured and the positive rate and distribution characteristics of the three antibodies were analyzed. Participants were divided into different groups according to the course of disease(<1 year,1-5 years, >5 years), antibody positivity(antibody-negative, antibody-positive) and types of positive antibodies(GADA+IA-2 A double positive, GADA single positive and IA-2 A single positive), respectively. Spearman correlation analysis was performed to explore the relationship between antibody characteristics and clinical features. Result Among the three antibodies, the positive rate of GADA(58%) was the highest, and the detection rate of the three antibodies(74%)was significantly higher than that of single antibody(P<0.05). The positive rate of islet autoantibodies and the number of positive antibodies decreased along with the prolongation of the disease course. The antibody-negative group had higher serum lipid levels than its antibody-positive counterparts. The disease course of IA-2A single positive group was longer than that of GADA+IA-2A double positive group and GADA single positive group. Conclusion The combined detection of multiple antibodies can improve the detection rate of antibodies and significantly reduce the rate of missed diagnosis of T1DM patients, especially those with atypical clinical characteristics. The positive rate of islet autoantibodies decreases along with prolonged disease duration and correlates with the clinical c haracteristics of patients in a certain degree.
Objective: To investigate the frequency and distribution of serum islet autoantibodies in patients with type 1 diabetes mellitus(T1DM) and their correlation with clinical features. Method 100 cases of T1DM patients who were diagnosed and treated in the Department of Endocrinology, Peking Union Medical College Hospital from January 2014 to December 2018 were recruited into the study. Serum isletcell antibody(ICA) and glutamic ac id decarboxylase antibody(GADA), protein tyrosine phosphatase antibody(IA-2A) were measured and the positive rate and distribution characteristics of the three antibodies were analyzed. Participants were divided into different groups according to the course of disease(<1 year,1-5 years, >5 years), antibody positivity(antibody-negative, antibody-positive) and types of positive antibodies(GADA+IA-2 A double positive, GADA single positive and IA-2 A single positive), respectively. Spearman correlation analysis was performed to explore the relationship between antibody characteristics and clinical features. Result Among the three antibodies, the positive rate of GADA(58%) was the highest, and the detection rate of the three antibodies(74%)was significantly higher than that of single antibody(P<0.05). The positive rate of islet autoantibodies and the number of positive antibodies decreased along with the prolongation of the disease course. The antibody-negative group had higher serum lipid levels than its antibody-positive counterparts. The disease course of IA-2A single positive group was longer than that of GADA+IA-2A double positive group and GADA single positive group. Conclusion The combined detection of multiple antibodies can improve the detection rate of antibodies and significantly reduce the rate of missed diagnosis of T1DM patients, especially those with atypical clinical characteristics. The positive rate of islet autoantibodies decreases along with prolonged disease duration and correlates with the clinical c haracteristics of patients in a certain degree.
引文
[1]Atkinson MA,Eisenbarth GS,Michels AW.Type 1 diabetes[J].Lancet,2014,383(9911):69-82.
[2]刘艺文,李玉秀.自身免疫性糖尿病相关抗体检测的研究进展[J].中华老年多器官疾病杂志,2016,15(1):69-72.
[3]Lampasona V,Liberati D.Islet autoantibodies[J].Curr Diab Rep,2016,16(6):53.
[4]American Diabetes Association.Diagnosis and classification of diabetes mellitus[J].Diabetes Care,2011,34 Suppl 1:S62-S69.
[5]钱莉,杨涛,姜惠,等.T1DM胰岛自身抗体与胰岛功能的关系[J].中华临床医师杂志(电子版),2017,11(5):728-733.
[6]顾愹,王知笑,杨慧,等.我国汉族T1DMHLA基因与4种胰岛自身抗体关系的研究[J].中国糖尿病杂志,2012,20(12):881-888.
[7]袁凤易,李生中,刘莉,等.T1DM胰岛自身抗体阳性率及其与病程的关系[J].广东医学,2018,39(3):368-372.
[8]周晖,李正康,徐晓明,等.胰岛自身抗体和生化指标在糖尿病分型诊断中的应用价值[J].重庆医学,2016,45(21):2909-2913.
[9]Wenzlau JM,Juhl K,Yu L,et al.The cation efflux transporter ZnT8(Slc30A8)is a major autoantigen in human type 1 diabetes[J].Proc Natl Acad Sci U S A,2007,104(43):17040-17045.
[10]Liu Y,Li J,Wu J,et al.A plasmon-enhanced fluorescence protein microchip with high-sensitivity for multiple islet autoantibodies measurements in autoimmune diabetes diagnosis[J].J Biomed Nanotechnol,2018,14(8):1496-1504.
[11]罗说明,黄干,李霞,等.不同胰岛自身抗体阳性T1DM临床特征分析[J].中国实用内科杂志,2012,32(1):49-52.
[2]刘艺文,李玉秀.自身免疫性糖尿病相关抗体检测的研究进展[J].中华老年多器官疾病杂志,2016,15(1):69-72.
[3]Lampasona V,Liberati D.Islet autoantibodies[J].Curr Diab Rep,2016,16(6):53.
[4]American Diabetes Association.Diagnosis and classification of diabetes mellitus[J].Diabetes Care,2011,34 Suppl 1:S62-S69.
[5]钱莉,杨涛,姜惠,等.T1DM胰岛自身抗体与胰岛功能的关系[J].中华临床医师杂志(电子版),2017,11(5):728-733.
[6]顾愹,王知笑,杨慧,等.我国汉族T1DMHLA基因与4种胰岛自身抗体关系的研究[J].中国糖尿病杂志,2012,20(12):881-888.
[7]袁凤易,李生中,刘莉,等.T1DM胰岛自身抗体阳性率及其与病程的关系[J].广东医学,2018,39(3):368-372.
[8]周晖,李正康,徐晓明,等.胰岛自身抗体和生化指标在糖尿病分型诊断中的应用价值[J].重庆医学,2016,45(21):2909-2913.
[9]Wenzlau JM,Juhl K,Yu L,et al.The cation efflux transporter ZnT8(Slc30A8)is a major autoantigen in human type 1 diabetes[J].Proc Natl Acad Sci U S A,2007,104(43):17040-17045.
[10]Liu Y,Li J,Wu J,et al.A plasmon-enhanced fluorescence protein microchip with high-sensitivity for multiple islet autoantibodies measurements in autoimmune diabetes diagnosis[J].J Biomed Nanotechnol,2018,14(8):1496-1504.
[11]罗说明,黄干,李霞,等.不同胰岛自身抗体阳性T1DM临床特征分析[J].中国实用内科杂志,2012,32(1):49-52.