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目的 评价联合检测谷氨酸脱羧酶抗体 (GADA)、胰岛细胞抗体 (ICA)、胰岛素自身抗体(IAA)等自身抗体和C肽对 1型糖尿病的预报价值。方法 采用间接酶联免疫吸附法检测GADA、ICA和IAA ,放射免疫法测定空腹和餐后血清C肽 ;GADA、ICA和IAA不同组合结果的诊断率运用矩阵决策法。结果 1型糖尿病患者的GADA、ICA和IAA阳性率分别为 6 8 8%、4 3 0 %和 39 8% ,显著高于 2型糖尿病患者和正常组 (P <0 0 1) ,其中GADA阳性率显著高于ICA和IAA(P <0 0 5 ) ;抗体阳性患者空腹和餐后C肽为 (30 6± 340 )pmol/L和 (72 4± 6 13)pmol/L ,明显低于抗体阴性患者 [(713±4 0 2 )pmol/L和 (15 94± 85 3)pmol/L ,P <0 0 0 1]。 3种自身抗体联合检测的敏感性、特异性、阳性预报率、阴性预报率和诊断符合率分别为 92 5 %、90 9%、96 6 %、81 1%和 92 1% ,其中敏感性、阴性预报率和符合率均显著高于单项 (39 8%～ 6 8 8%、36 4 %～ 5 1 7%和 5 4 8%～ 75 4 % )或双项 (70 9%～83 9%、5 4 2 %～ 6 7 4 %和 77 8%～ 86 5 % )测定。结论 自身抗体阳性患者胰岛功能有明显损伤 ;GADA、ICA和IAA是 1型糖尿病与 2型糖尿病相鉴别的重要免疫学标志 ;3种自身抗体阳性率并不一致 ,联合检测可显著提高检验诊断率 ,对 1型糖?
Objective To evaluate the value of combined detection of autoantibodies such as glutamic acid decarboxylase antibody (GADA), islet cell antibody (ICA), insulin autoantibodies (IAA) and C-peptide on type 1 diabetes mellitus. Methods The GADA, ICA and IAA were detected by indirect enzyme-linked immunosorbent assay (ELISA), fasting and postprandial serum C-peptide were determined by radioimmunoassay. The diagnostic rates of different combinations of GADA, ICA and IAA were determined by matrix method. Results The positive rates of GADA, ICA and IAA in type 1 diabetic patients were 68.8%, 430% and 398%, respectively, which were significantly higher than those in patients with type 2 diabetes and normal controls (P <0.01), of which GADA was positive (P <0.05). The fasting and postprandial C-peptide in patients with antibody-positive were (30 6 ± 340) pmol / L and (72 4 ± 6 13) pmol / L respectively, which were significantly lower than that of the antibody Negative patients [(713 ± 420) pmol / L and (1594 ± 853) pmol / L, P <0.01]. The sensitivity, specificity, positive predictive rate, negative predictive rate, and diagnostic coincidence rate of the three autoantibodies were 92.5%, 90.9%, 96.6%, 81.1% and 92.1% respectively. The sensitivity, Negative predictive rate and coincidence rate were significantly higher than those of single items (39.8% ~ 68.8%, 36.4% ~ 51.7% and 54.8% ~ 75.4%) or double items (70.9% ~ 83.9% , 542% to 67 4% and 77 8% to 86 5%). Conclusions GADA, ICA and IAA are important immunological markers differentiating type 1 diabetes mellitus and type 2 diabetes mellitus. The positive rates of 3 autoantibodies are not consistent, and the combined detection can significantly improve the diagnostic rate of the test, For type 1 sugar?