董维平 张洪德 胡远峰 张爱芳 王丽娟 王煜非 200080 上海市第一人民医院，糖尿病研究室 中华内分泌代谢杂志 1999 0 15 5


    关键词：谷氨酸脱羧酶；胰岛细胞；抗体；糖尿病1型；诊断 期刊 zhnfmdxzz 0 论著 fur -->


    

【摘要】 目的 对984例糖尿病患者的胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体(GADA)和血清C肽进行了检测与分析，了解ICA和GADA阳性率以及阳性患者的胰岛功能情况，以明确ICA和GADA检测对1型糖尿病早期诊断的意义。方法 采用免疫组化法检测ICA，ELISA法定量检测GADA，放 射免疫法检测血清空 腹和餐后C肽。结果 ICA和(或)GADA阳性(阳性组)168例(17.0%)高于ICA阳性率(10.5%)和GADA阳性率(12.0%，P<0.05)。成年患者GADA阳性率(10.5%)高于ICA(7.7%，P<0.05)，青少年患者 ICA阳性率(46.5%)高于GADA(31.0%，P<0.01)。抗体阳性患者的空腹和餐后C肽〔(325±368)pmol/L和(745±767)pmol/L〕明显低于抗体阴性患者〔(701±434)pmol/L和(1614±967)pmol/L,P<0.001〕。结论 自身抗体阳性患者的胰岛功能明显低于阴性患者，提示自身抗体阳性患者胰岛功能有明显损伤。在成年糖尿病患者中GADA检测较ICA更为重要，而在青少年糖尿病患者中则ICA阳性率高于GADA。两种抗体的阳性结果常不一致，联合检测可提高诊断的敏感性，对1型糖尿病的早期诊断有重要意义。

Significance of combineddetermination of GADA and ICA in early diagnosis of type 1 diabetes mellitus

DONG Weiping,ZHANG Hongde,HU Yuanfeng,et al.Diabetes Research Laboratory,Shanghai First People's Hospital,200080

【 Abstract】 Objective To evaluate the significance of islet cell antibody (ICA)and glutamic acid decarboxylase antibody (GADA) determination in the early diagnosis oftype 1 diabetes mellitus, ICA, GADA and serum C-peptide of 984 patients with diabetesmellitus were measured and analysed. Methods ICA was determined with immunohistochemical method, GADAwith enzyme-linked immunosorbent assay and serum C-peptide with radioimmunoassay. Results The positive rate of ICA and(or)GADA (positive group) was higher than that of ICA (17.0% versus 10.5%, P< 0.05) and that of GADA (17.0%versus 12.0%, P< 0.05).In adult diabetics, the positive rate of GADA was higher than that of ICA (10.5% versus7.7%, P< 0.05), whilein juvenile diabetics, the positive rate of ICA was higher than that of GADA (46.5% versus31.0%, P< 0.01).Fasting and postprandial C-peptide of antibody positive diabetics 〔 (325±368)pmol/L and (745±767)pmol/L〕 were significantly lower than those ofantibody negative diabetics 〔 (701±434)pmol/L and (1 614±967)pmol/L〕 , P< 0.001. Conclusion The islet function of diabetics with positive antibodieswas significantly lower than that of diabetics with negative antibodies, indicating thatin the former islet function was markedly damaged. The assay of GADA was more importantthan ICA in adult diabetics and the positive rate of ICA in juvenile diabetics was higherthan that of GADA. The combined determination of GADA and ICA may enhance the sensitivityof diagnosis, having an important significance for early diagnosis of type 1 diabetesmellitus.

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