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目的:探讨谷氨酸脱羧酶抗体(GADA)、胰岛细胞抗体(ICA)和抗胰岛素抗体(IAA)在成人隐匿性自身免疫糖尿病(LADA)诊断中的价值。方法:入选150例初诊为2型糖尿病(T2DM)的患者和80例正常糖耐量者,测定其血清GADA、ICA和IAA,并行胰岛素释放试验及C肽释放试验。结果:初诊为T2DM患者血清中GADA、ICA及IAA抗体的阳性率分别为20.0%、14.0%和8.0%,有一种或以上抗体阳性者占30%。与对照组比较,血清中有一种或以上胰岛自身抗体阳性的DM患者的胰岛素和C肽分泌水平明显下降,其中三种抗体全阳性组患者下降最为显著,差别均有统计学意义(P<0.01)。结论:临床初诊为T2DM的病人中存在被误诊的LADA患者,多种胰岛自身抗体联合检测可提高LADA的检出率。
Objective: To investigate the value of glutamic acid decarboxylase antibody (GADA), islet cell antibody (ICA) and anti-insulin antibody (IAA) in the diagnosis of adult latent autoimmune diabetes (LADA). Methods: 150 patients with newly diagnosed type 2 diabetes mellitus (T2DM) and 80 normal glucose tolerance were enrolled in the study. Their serum GADA, ICA and IAA, parallel insulin release test and C peptide release test were measured. Results: The positive rates of GADA, ICA and IAA antibodies in newly diagnosed T2DM patients were 20.0%, 14.0% and 8.0%, respectively, and those with one or more antibodies were 30%. Compared with the control group, the levels of insulin and C-peptide secretion in DM patients with one or more islet autoantibodies in serum were significantly decreased, of which the three antibody positive groups showed the most significant decrease (P <0.01 ). Conclusion: There are misdiagnosed LADA patients in the newly diagnosed T2DM patients. Combined detection of multiple islet autoantibodies may improve the detection rate of LADA.