1型糖尿病胰岛自身抗体阳性率及其与病程的关系

摘要

目的 分析成年1型糖尿病(T1DM)患者胰岛自身抗体阳性率及其与病程的关系.方法 收集52例T1DM患者及67例健康对照病历资料,血清标本进行生化及糖代谢检测,放射配体法检测血清谷氨酸脱羧酶抗体(GADA)、蛋白酪氨酸磷酸酶抗体(IA-2A)、锌转运体8抗体(ZnT8A).比较抗体阳性T1DM患者与抗体阴性患者临床特征,并根据病程将患者分为4组:< 1年,1～5年(不含5年),5～10(不含10年)年及≥10年,比较不同病程组抗体阳性率.结果 胰岛自身抗体总阳性率(至少一个抗体阳性)53.85％;GADA、IA-2A、ZnT8A阳性率分别为50.00％、21.15％、9.62％.与抗体阴性组相比,抗体阳性组患者起病年龄较高、病程更短、血肌酐更低,并且独生子女比例更高(P＜0.05);多因素logistic回归分析校正血肌酐、独生子女等影响后,病程仍是胰岛自身抗体阳性的独立影响因素(OR=0.785,95％ CI 0.623～0.989,P＜0.05).病程1～5年(不含5年)组抗体阳性率最高,可达80.0％.结论 一半以上成年T1DM患者胰岛自身抗体阳性,GADA阳性率显著高于IA-2A及ZnT8A;胰岛自身抗体总阳性率及GADA阳性率在不同病程中分布有所不同.%Objective To explore the prevalence of islet autoantibodies in adults with type 1 diabetes mellitus( T1DM) and its association with disease duration. Methods The clinical data of 52 adults with T1DM and 67 healthy controls were collected. Serum samples were used of for biomedical, glucose and lipid tests. Islet diabetes, such as glutamic acid decarboxylase antibody ( GADA) , protein tyrosine phosphatase antibody ( IA-2A) , and zinc transporter eight antibody ( ZnT8A) were detected by radio-ligand assay. The clinical characteristics of patients with autoantibody positive and autoantibody negative were compared. Furthermore, the patients were divided into four groups according to the duration:< 1 year, 1-5years, 5-9 years and ≥10 years. Results Twenty-eight ( 53. 85％) patients were positive for at least one antibody. Among the patients with single positive antibody, 26 ( 50. 00％) , 11 ( 21. 15％) and 5 ( 9. 62％) patients were positive for GADA, IA-2A and ZnT8A, respectively. Compared with antibody-negative group, the patients with antibody positive were later onset, with shorter duration and lower serum creatinine, and were more likely to be only child ( P＜ 0. 05 for each) . The disease duration was strong associated with the prevalence of the antibodies after adjustment for other significant factors using logistic analysis ( OR =0. 785, 95％ CI 0. 623-0. 989, P＜ 0. 05) . 80. 0％ of patients were positive for antibody in duration group of 1-5 years. Conclusion More than half of the adults with T1DM are positive for islet autoantibodies. The prevalence of GADA is significantly higher than IA-2A and ZnT8A. The prevalence of the antibodies depends on the disease duration.