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目的探讨谷氨酸脱羧酶抗体(GAD-Ab)、胰岛细胞抗体(ICA)在妊娠糖尿病(GDM)患者中的临床意义。方法选取GDM孕妇68例(GDM组)和糖耐量正常孕妇40例作对照组(NGT组),检测GAD-Ab、ICA和胰岛素水平,以稳态模型HOMA-IR计算胰岛素抵抗指数及HBCI计算胰岛β细胞功能指数。结果68例GDM组中40.0%患者有一种以上抗体阳性,其中26.0%患者GAD-Ab阳性,24.0%患者ICA阳性,10.0%患者两种抗体均为阳性,与NGT组比较有统计学差异(P<0.05～0.01);胰岛自身抗体阳性的GDM孕妇空腹胰岛素(FIns)、HOMA-IR和HBCI均低于抗体阴性组,差异有统计学意义(P<0.05)。结论GDM孕妇中存在亚临床状态的1型糖尿病患者,胰岛自身抗体阳性是胰岛β细胞功能损伤的一个预测指标,也是GDM孕妇产后发展为1型糖尿病的一个重要预测因素。
Objective To investigate the clinical significance of glutamic acid decarboxylase antibody (GAD-Ab) and islet cell antibody (ICA) in patients with gestational diabetes mellitus (GDM). Methods Sixty-four pregnant women with GDM (GDM group) and 40 normal pregnant women with glucose tolerance (GDM group) were selected as the control group (NGT group). The levels of GAD-Ab, ICA and insulin were measured. Insulin resistance index (HOMA-IR) and HBCI β-cell function index. Results There were more than one antibody positive in 40.0% of 68 GDM patients, of which 26.0% were positive for GAD-Ab, 24.0% were positive for ICA, and 10.0% were positive for both antibodies (P <0.05 ~ 0.01). Fasting insulin (FIns), HOMA-IR and HBCI in GDM pregnant women with islet autoantibody were lower than those in antibody negative group (P <0.05). Conclusions There is subclinical type 1 diabetes in GDM pregnant women. The positive of islet autoantibody is a predictor of pancreatic β-cell function impairment and an important predictor of type 1 diabetes in GDM pregnant women.