老年2型糖尿病患者胰岛自身免疫抗体与超敏-CRP和肾功能指标变化的临床分析

摘要

目的探讨老年2型糖尿病（T2DM ）患者血清谷氨酸脱羧酶抗体（GAD-Ab）、胰岛细胞抗体（ICA ）、胰岛素自身抗体（IAA）与超敏C反应蛋白（hs-CRP）和肾功能指标变化的临床价值。方法选择2012年1月至2012年12月在该院内分泌科住院确诊的T2DM患者122例，根据抗体检测结果将患者分为胰岛自身免疫抗体阳性组（n＝21）和胰岛自身免疫抗体阴性组（n＝101），检测其空腹C肽（FCP）、餐后2 h C肽（2 h CP）、糖化血红蛋白（HbA1c）、hs-CRP和肾功能指标[尿素（UREA）、肌酐（Cr）、尿微量清蛋白（尿mALB），尿β2-微球蛋白（尿β2-MG）]，并对检测结果进行分析比较。结果122例老年T2DM患者检出至少有1种胰岛自身免疫抗体阳性者共21例，阳性率为17．21％。其中检出单项抗体GAD-Ab阳性14例（11．47％）、ICA阳性10例（8．19％）、IA A阳性1例（0．82％），检出2种抗体阳性患者4例（3．27％），未检出3种抗体均为阳性的患者。胰岛自身免疫抗体阳性组其hs-CRP、UREA、Cr水平高于胰岛自身免疫抗体阴性组，差异有统计学意义（P＜0．05）。而 FCP、2 h CP、HbA1c、尿mALB、尿β2-MG水平与胰岛自身免疫抗体阴性组比较差异均无统计学意义（P＞0．05）。结论老年 T2DM 患者的慢性炎症反应和胰岛自身抗体的出现与胰岛细胞功能的损伤密切相关；了解患者胰岛自身免疫抗体、炎症和肾功能指标的变化情况，对老年T2DM 患者及其并发症的监测和疗效观察有较高的价值。%Objective To investigate the clinical value in changes of serum glutamic acid decarboxylase antibody (GAD-Ab) ,islet cell antibodies(ICA) ,insulin autoantibodies (IAA) and high-sensitivity C-reactive protein (hs-CRP) and renal function in elderly type 2 diabetic patients .Methods 122 cases of endocrine inpatient in our hospital had been diagnosed with type 2 diabetes were chosen from January 2012 to December 2012 .They were divided into islet autoimmunity antibody positive group (n=21) and islet autoimmunity antibody negative group (n=101) according to the antibody test results ,Fasting C-peptide(FCP) ,2-hour postprandial C-peptide(2 h CP) ,glycosylated hemoglobin(HbA1c) ,high-sensitivity-CRP(hs-CRP) and renal function[urea (UREA) ,creatinine (Cr) ,microalbuminuria(urinary mALB) ,urinary β2-microglobulin (urinary β2-MG)]were detected .Test results were statistically analyzed and compared .Results At least one Islet autoimmune antibodies were found in 21 cases of 122 elderly patients with type 2 diabetes .The positive rate was 17 .21% .GAD-Ab was detected positive in 14 cases(11 .47% ) ,ICA was detected positive in 10 ca-ses(8 .19% ) ,IAA was detected positive in 1 case(0 .82% ) ,Two antibodies were detected positive together in 4 patients(3 .27% ) , Three antibodies were not detected positive together .The levels of hs-CRP ,UREA and Cr in Islet autoantibodies positive group were higher then in islet autoimmunity antibody negative group ,the difference was statistically significant (P<0 .05) .The levels of FCP ,2 h CP ,HbA1c ,urinary mALB and urinary β2-MG in both group ,the difference was not statistically significant (P>0 .05) . Conclusion Chronic inflammation and the appearance of islet autoantibodies are closely related to the damage of islet cell function . It has a higher value in monitoring complications and efficacy through understanding islet autoantibodies ,inflammation and changes in renal function in elderly type 2 diabetes .