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目的分析胰岛自身抗体与β细胞功能关系,探讨胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体(GADA)在类似2型糖尿病的成人隐匿性自身免疫糖尿病(LADA)中的诊断价值,指导临床糖尿病分型诊断和治疗。方法初诊2型糖尿病病人70例,正常糖耐量者70例,测定ICA、GADA及胰岛素释放,计算胰岛素分泌指数(HOMA-IS)、胰岛素抵抗指数(HOMA-IR)及ICA、GADA阳性率。初诊2型糖尿病自身抗体阳性组与阴性组进行年龄、体重指数(BMI)、腰臀比值(WHR)、糖化血红蛋白(HbA1c)、空腹和餐后2h胰岛素(FINS、餐后2hINS2h)、HOMA-IS及HOMA-IR等临床特征比较。结果初诊2型糖尿病组ICA阳性率为11.4%,正常糖耐量组为0.0%(P<0.01);GADA阳性率在糖尿病组为18.6%,正常糖耐量组为4.3%(P<0.01)。空腹及餐后2h胰岛素在抗体阳性组明显低于阴性组(P<0.001);HOMA-IS指数及HOMA-IR指数在抗体阴性组、抗体单阳性组及双阳性组依次降低。结论临床诊断为2型DM病人中可能有LADA病人,抗体阳性者胰岛功能明显低于抗体阴性者,提示其胰岛功能有明显损伤,而抗体阴性组胰岛素抵抗明显,提示胰岛自身抗体结合胰岛β细胞功能对LADA病人早期诊断有帮助。
Objective To analyze the relationship between islet autoantibodies and β-cell function, and to investigate the diagnostic value of islet cell antibody (ICA) and glutamic acid decarboxylase antibody (GADA) in adult latent autoimmune diabetes mellitus (T2DM) Diabetes diagnosis and treatment. Methods Seventy patients with newly diagnosed type 2 diabetes mellitus and 70 normal glucose tolerance patients were recruited. ICA, GADA and insulin release were measured. HOMA-IS, HOMA-IR, ICA and GADA positive rates were calculated. The BMI, WHR, HbA1c, fasting and postprandial 2h insulin (FINS, postprandial 2hINS2h), HOMA-IS And HOMA-IR and other clinical features comparison. Results The positive rate of ICA in newly diagnosed type 2 diabetic patients was 11.4% and that in normal glucose tolerance patients was 0.0% (P <0.01). The positive rate of GADA was 18.6% in diabetic patients and 4.3% in normal glucose tolerance patients (P <0.01). Fasting and postprandial 2h insulin in antibody positive group was significantly lower than negative group (P <0.001); HOMA-IS index and HOMA-IR index in antibody negative group, antibody single positive group and double positive group decreased in turn. Conclusions There may be LADA patients in type 2 diabetes mellitus. The islet function of patients with positive antibody is significantly lower than those with negative antibody, which indicates that the function of islets is obviously damaged. However, the antibody negative group has obvious insulin resistance, which indicates that islet autoantibodies bind to islet β cells Function of early diagnosis of LADA patients helpful.