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目的探讨隐匿性自身免疫缺陷糖尿病(LADA)患者血清谷氨酸脱羧酶抗体(GAD)以及胰岛细胞抗体(ICA)对患者病情发展的预测价值。方法选取LADA单纯ICA阳性(ICA+)患者10例,单纯GAD阳性(GAD+)15例以及ICA与GAD同为阳性者15例,并选取ICA及GAD同为阴性的T2MD患者20例,连续对各组患者随访3年(6个月随访1次),测定患者空腹C肽(FCP)水平。结果随访第2年中,单纯GAD+者、GAD+与ICA+同为阳性者FCP水平显著下降,而单纯ICA+及T2MD患者FCP及2hFGP水平无明显变化,差异有统计学意义(P<0.05)。结论 GAD+的LADA患者其胰岛B细胞衰退功能较单纯ICA+及T2MD患者下降更快,GAD+可作为预测胰岛功能衰退的重要指标。
Objective To investigate the predictive value of serum glutamic acid decarboxylase antibody (GAD) and islet cell antibody (ICA) in patients with occult autoimmune diabetes (LADA). Methods Totally 10 patients with simple ICA positive (ICA +) in LADA, 15 with simple GAD positive (GAD +) and 15 with positive ICA and GAD were enrolled in this study. Twenty patients with ICA and GAD negative T2MD were enrolled in this study. Patients were followed up for 3 years (6 months follow-up 1), determination of fasting C-peptide (FCP) levels. Results In the second year of follow-up, the levels of FCP in patients with GAD +, GAD + and ICA + were significantly decreased, while the levels of FCP and 2hFGP in ICA + and T2MD patients had no significant difference (P <0.05). Conclusions The declining function of pancreatic islet B cells in LADA patients with GAD + declines faster than that of ICA + and T2MD patients alone. GAD + may be used as an important index to predict the decline of pancreatic islet function.