摘要
目的 :探讨胰岛细胞抗体 (ICA)和谷氨酸脱羧酶抗体 (GAD Ab)对成人隐匿性自身免疫糖尿病 (LADA)患者胰岛功能的影响和预测价值。方法 :对单独ICA阳性的LADA14例 ,单独GAD Ab阳性的LADA 10例 ,GAD Ab和ICA同时阳性的LADA 7例 ,两抗体均阴性的 2型糖尿病 (T2DM) 2 5例 ,每半年随访一次 (第 2年除外 )直至第 5年 ,测定患者空腹C肽 (FCP)和 10 0g馒头餐后 2hC肽 (2°CP)及糖代谢指标。采用放射免疫法测定GAD Ab和C肽 ,酶联免疫吸附法 (ELISA)测定ICA。结果 :单独GAD Ab阳性和两抗体均阳性组的FCP从随访第 2 .5年开始下降 ,FCP较入组时下降≥ 5 0 %的患者百分比分别从第 3年和第 3.5年升至 6 0 %和 71.4 % ,单独ICA阳性组和抗体阴性的T2DM组则无显著性变化。单独GAD Ab阳性组中 4 / 10例、两抗体均阳性组 1/ 10例出现胰岛功能衰竭 ,前者与单独ICA阳性组 (0 / 14例 )和两抗体均阴性组 (0 / 2 5例 )比较有统计学意义 (均P <0 .0 5 )。ICA与FCP间无显著性相关 (rs= 0 .2 5 8,P <0 .0 5 ) ,多元回归分析显示GAD Ab对FCP的影响远大于ICA。结论 :GAD Ab阳性的LADA患者胰岛 β细胞功能较ICA阳性的LADA以及T2DM下降更快 ,GAD Ab滴度是预测胰岛功能减退速度的重要因素 。
Objective To explore the predictive value and influence of islet cell antibody (ICA) and glutamic acid decarboxylase antibody (GAD-Ab) for β cell function in latent autoimmune diabetes in adults(LADA) patients.Methods Fifty-six patients with initially diagnosed type 2 diabetes (including 10 cases of GAD-Ab-positive alone, 14 ICA-positive alone, 7 GAD-Ab and ICA-positive and 25 GAD-Ab and ICA negative) were followed up every 6 months (except the 2nd year) until the 5th year. Their fasting and postprandial C-peptide and glycemic control were measured. GAD-Ab was determined by radioimmunoprecipitation assay and ICA by ELISA kit. Results Decreased fasting C-peptide was found in patients with GAD-Ab alone and patients with GAD-Ab and ICA in the 2.5th year and to the end of the follow-up. The percentage of patients whose C-peptide decreased 50% or more compared with the baseline in the above 2 groups reached 60.0% in the 3nd year and 71.4% in the 3.5th year,respectively. No changes of the above parameters were found in ICA-positive alone group and GAD-Ab and ICA negative group. Complete β-cell failure was found in 4 of the 10 patients in GAD-Ab alone group and in 1 of the 10 patients in ICA and GAD-Ab positive group. The number of failure patients in GAD-Ab alone group was more than that of the other 2 groups (P<0.05 in both groups). There was no significant correlation between ICA index and FCP. Multiple stepwise regression analysis demonstrated that GAD-Ab contributed much more to FCP than ICA did.Conclusion The islet β cell function decreases more quickly in GAD-Ab positive LADA patients than in ICA positive ones. The titer of GAD-Ab is an important prognostic factor in islet β cell function, and the presentation of ICA-positive alone can not predict β cell function in LADA patients.
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2004年第3期309-314,共6页
Journal of Central South University ：Medical Science
基金
国家自然科学基金 (39370 343)
卫生部优秀青年科技人才基金 (Q942 0 )
湖南省卫生厅重点科研基金(9736
2 0 0 1 Z0 4 )
关键词
胰岛细胞
抗体
阳性
隐匿性
自身免疫
糖尿病
Β细胞功能
GAD-AB
ICA
latent autoimmune diabetes in adults
islet β-cell function
glutamic acid decarboxylase antibody
islet cell antibody
