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目的 探讨羧基肽酶 H自身抗体 (CPH Ab)阳性的 2型糖尿病 (T2DM)患者的临床特征及该抗体对成人隐匿性自身免疫糖尿病 (LADA)的诊断价值。 方法 选择临床初诊为T2DM患者 5 4 5例 ,1型糖尿病 (T1DM)患者 85例 ,健康对照 12 3例进行CPH Ab测定 ,同时检测T2DM患者谷氨酸脱羧酶抗体 (GAD Ab)。比较各组CPH Ab的阳性率以及T2DM中依据CPH Ab、GAD Ab划分的 3组患者的临床特点。采用放射免疫沉淀法检测CPH Ab和GAD Ab。 结果 CPH Ab阳性率在T2DM患者 ( 5 .5 % ,30 /5 4 5 )高于T1DM患者 ( 0 % ,0 / 85 )和正常对照 ( 0 .8% ,1/ 12 3) (P <0 .0 5 ) ,30例CPH Ab阳性的T2DM患者只有 1例同时GAD Ab阳性。CPH Ab在低体重 (BMI<2 1kg/m2 )者中的阳性率较高 ,且该抗体阳性的患者具有起病年龄跨度大、病程较长、低体重、易发生酮症等特点 ,其空腹C肽介于GAD Ab阳性与两种抗体(GAD Ab和CPH Ab)均阴性的T2DM患者之间 ,反映代谢综合征的指标水平较低 (包括较低的BMI、血压和甘油三酯 ) ,而周围神经病变的比例较高。 结论 CPH Ab阳性糖尿病患者的临床特点介于经典的LADA(GAD Ab阳性 )与T2DM患者间。CPH抗体检测是LADA诊断的一项新指标
Objective To investigate the clinical features of patients with type 2 diabetes mellitus (T2DM) diagnosed with carboxypeptidase H autoantibodies (CPH Ab) and the diagnostic value of this antibody in adult latent autoimmune diabetes mellitus (LADA). Methods A total of 545 newly diagnosed T2DM patients, 85 patients with type 1 diabetes mellitus (T1DM) and 123 healthy controls were enrolled in this study. CPH Ab was measured in patients with T2DM, and glutamic acid decarboxylase antibody (GAD Ab) was also detected in patients with T2DM. The positive rate of CPH Ab in each group was compared with the clinical features of 3 groups according to CPH Ab and GAD Ab in T2DM. CPH Ab and GAD Ab were detected by radioimmunoprecipitation. Results The positive rate of CPH Ab in T2DM patients was significantly higher than that in T1DM patients (0%, 0/85) and normal controls (0.8%, 1/123) (P <0. 05) .0 5). Only 1 of 30 patients with positive CPH-Ab positive T2DM had positive GAD-Ab. The positive rate of CPH Ab in patients with low body weight (BMI <2 1kg / m2) is high, and the patients with positive antibody have the characteristics of large age span, long duration, low body weight and susceptibility to ketosis. C-peptide is between GAD-Ab positive and T2DM patients who are both negative for both antibodies (GAD Ab and CPH Ab) and reflects lower levels of metabolic syndrome (including lower BMI, blood pressure, and triglycerides) A higher proportion of peripheral neuropathy. Conclusions The clinical features of patients with CPH-Ab positive diabetes ranged from the classic LADA (GAD-Ab positive) to T2DM patients. CPH antibody test is a new indicator of the diagnosis of LADA