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目的探讨谷氨酸脱羧酶抗体(GAD Ab)、酪氨酸磷酸酶抗体(IA2Ab)和胰岛素自身抗体(IAA)在以自发酮症起病的新发糖尿病患者中的分布规律及其与起病状况、胰腺β细胞功能的关系。方法对161例以自发酮症起病的新发糖尿病患者,以放射配体法测定GAD Ab、IA2Ab和IAA。比较胰岛自身抗体在不同发病年龄组、不同体重指数(BMI)组、不同程度酮症组及不同空腹C肽(FCP)水平组的阳性率,比较胰岛自身抗体阳性与阴性组起病状况和胰腺β细胞功能的差异。结果161例患者中,共68例(42.2%)被检出存在1种或多种胰岛自身抗体,其中胰岛自身抗体在起病年龄≤20岁、BMI≤18.5、FCP水平较低患者中阳性率较高;与胰岛自身抗体阴性组相比,抗体阳性组存在发病年龄较轻、BMI较低、发病时酮症程度较严重、胰岛分泌功能较差等特点。结论在以自发酮症起病的糖尿病患者中,发病年龄较小、BMI较低、C肽水平较低的患者胰岛自身抗体的阳性率较高,属于1A型糖尿病的可能性较大,属于1B型或2型糖尿病的可能性较小。胰岛自身抗体阳性的患者β细胞分泌功能较差,应尽早予胰岛素治疗。
Objective To investigate the distribution of glutamate decarboxylase antibody (GAD Ab), tyrosine phosphatase antibody (IA2Ab) and insulin autoantibodies (IAA) in newly diagnosed diabetic patients with spontaneous ketosis and its association with onset Status, pancreatic β-cell function. Methods 161 newly diagnosed diabetic patients with spontaneous ketosis were assayed for GAD Ab, IA2Ab and IAA by radioligand method. To compare the positive rate of islet autoantibodies in different age groups, different body mass index (BMI) group, different degrees of ketosis group and different fasting C-peptide (FCP) levels, comparing the onset status of islet autoantibody positive and negative group and pancreas Differences in beta cell function. Results Of the 161 patients, 68 (42.2%) were detected with one or more islet autoantibodies. The positive rate of islet autoantibodies in patients with onset ≤ 20 years of age, BMI ≤ 18.5, and low FCP levels Higher; compared with the negative group of islet autoantibodies, antibody-positive group had the characteristics of younger onset age, lower BMI, severe ketosis incidence and poor pancreatic secretion. Conclusions Among diabetic patients with spontaneous ketosis, patients with younger onset age, lower BMI, and lower C-peptide levels have a higher positive rate of islet autoantibodies and are more likely to have type 1A diabetes, Type 2 or type 2 diabetes is less likely. Islet autoantibodies in patients with poor beta-cell secretion, insulin treatment should be given as soon as possible.