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目的 探讨糖尿病患者谷氨酸脱羧酶抗体和血、尿C肽测定的临床价值。方法 观察 2型糖尿病、成人隐匿型自身免疫性糖尿病、1型糖尿病患者及正常人的谷氨酸脱羧酶、馒头餐前后血C肽和 2 4h尿C肽浓度的变化 ,并进行对比分析。结果 谷氨酸脱羧酶检测 :2型糖尿病组均为阴性 ,成人隐匿型自身免疫性糖尿病组均为阳性 ,1型糖尿病组 7例阳性 ,5例阴性 ,正常对照组均为阴性。 2 4h尿C肽分泌总量 :2型糖尿病组显著高于成人隐匿型自身免疫性糖尿病组和 1型糖尿病组 (P <0 .0 1) ,与正常对照组比较无显著差异 (P >0 .0 5 ) ;成人隐匿型自身免疫性糖尿病组高于 1型糖尿病组 (P <0 .0 5 ) ;成人隐匿型自身免疫性糖尿病组和 1型糖尿病组明显低于正常对照组 (P <0 .0 1)。馒头餐试验各时相血C肽浓度 :与正常对照组相比 ,2型糖尿病组空腹血C肽浓度无显著差异 ,餐后血C肽升高缓慢 ,下降也缓慢 ,成人隐匿型自身免疫性糖尿病组和 1型糖尿病组空腹及餐后各时相血C肽浓度明显降低 (P <0 .0 1) ;且 1型糖尿病组降低更明显(P <0 .0 5 )。结论 谷氨酸脱羧酶抗体是反映 1型糖尿病胰岛B细胞自身抗体的免疫学指标 ,血、尿C肽是反映糖尿病胰岛B细胞功能的可靠指标 ,二者联合检测有重要临床意义。
Objective To investigate the clinical value of determination of glutamic acid decarboxylase antibody and blood and urine C-peptide in patients with diabetes mellitus. Methods The changes of glutamic acid decarboxylase, C-peptide and 24-h urinary C-peptide in patients with type 2 diabetes, latent autoimmune diabetes in adults, patients with type 1 diabetes mellitus and normal subjects were observed and compared. Results Glutamate decarboxylase assay showed that all patients with type 2 diabetes were negative and all patients with latent autoimmune diabetes were positive. Seven patients were positive in type 1 diabetes mellitus, 5 were negative and all were negative in normal control group. The total amount of urinary C-peptide secretion in type 2 diabetes mellitus group was significantly higher than that in latent autoimmune diabetes mellitus group and type 1 diabetes mellitus group (P <0.01), and no significant difference compared with normal control group (P> 0 .0 5). The level of latent autoimmune diabetes in adults was higher than that in type 1 diabetic patients (P <0.05). The levels of latent autoimmune diabetes mellitus and type 1 diabetes in adults were significantly lower than those in normal controls (P < 0 .0 1). Compared with the normal control group, there was no significant difference in C-peptide concentration in fasting blood between type 2 diabetes mellitus patients. The postprandial blood C-peptide increased slowly and slowly, and the latent autoimmune The fasting and postprandial levels of blood C-peptide in diabetic group and type 1 diabetic group were significantly lower (P <0.01), and those in type 1 diabetic group were more obvious (P <0.05). Conclusions Glutamic acid decarboxylase antibody is an immunological indicator of autoantibodies to islet B cells in type 1 diabetic patients. Blood and urine C-peptide is a reliable indicator of the function of islet B cells in diabetic patients. The combined detection of them has important clinical significance.