ICA、GAD-Ab、IAA联合检测在成人隐匿性自身免疫性糖尿病诊断中的应用

秦雪鸽 马斌 关慷慷 苗媛媛

【摘要】 目的 分析胰島素细胞抗体（insulin cell antibody，ICA）、谷氨酸脱羧酶抗体（glutamic acid decarboxylase antibody，GAD-Ab）、胰岛素自身抗体（insulin autoantibody，IAA）联合检测在成人隐匿性自身免疫性糖尿病（latent autoimmune diabetes mellitus in adults，LADA）诊断中的应用价值。

方法 选取2019年1～12月期间收治的LADA患者30例为观察组，选取同期收治的2型糖尿病患者30例为对照组。分别测定并比较两组研究对象的ICA、GAD-Ab、IAA水平，应用ROC曲线下面积（AUC）评价ICA、GAD-Ab、IAA联合检测对LADA的诊断价值。

结果 观察组ICA、GAD-Ab、IAA阳性表达率均高于对照组，差异有统计学意义（P<0.05）;绘制ROC曲线显示，ICA预测LADA的AUC为0.650;GAD-Ab预测LADA的AUC为0.767;IAA预测LADA的AUC为0.617;联合检测预测LADA的AUC为0.783;联合检测的诊断价值较好。

结论 ICA、GAD-Ab、IAA联合检测在LADA患者中的诊断效果较好，可提高对LADA诊断的准确性，为后续治疗及患者预后评估提供较为客观的参考价值。

【关键词】 成人隐匿性自身免疫性糖尿病;胰岛素细胞抗体;谷氨酸脱羧酶抗体;胰岛素自身抗体;诊断价值

中图分类号：R587.1   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.03.013

Application of combined detection of ICA， GAD-Ab and IAA in diagnosis of LADA

QIN Xuege， MA Bin， GUAN Kangkang， MIAO Yuanyuan

（Nuclear Medicine Department， Luoyang Central Hospital Affiliated to Zhengzhou University， Luoyang 471000， Henan， China）

【Abstract】 Objective To analyze the application value of combined detection of insulin cell antibody （ICA）， glutamate decarboxylase antibody （GAD-Ab） and insulin autoantibody （IAA） in the diagnosis of latent autoimmune diabetes mellitus in adults.

Methods 30 patients with LADA who were treated in hospital from January 2019 to December 2019 were selected as observation group， and 30 patients with type 2 diabetes who treated in hospital during the same period were selected as control group. The ICA， GAD-Ab and IAA levels of the two groups were measured and compared， and the area under ROC curve （AUC） was used to evaluate the diagnostic value of combined detection of ICA， GAD-Ab and IAA in LADA.

Results The positive expression rates of ICA， GAD-Ab and IAA in the observation group were higher than those in the control group， and  difference was statistically significant （P<0.05）; the ROC curve was drawn to show that the AUC of LADA predicted by ICA was 0.650， predicted by GAD-Ab was 0.767， predicted by IAA was 0.617， and predicted by combined test was 0.783. The diagnostic value of the combined test was better.

Conclusion Combined detection of ICA， GAD-Ab and IAA has a better diagnosis effect in LADA patients， which can improve the accuracy of LADA diagnosis and provide a more objective reference value for subsequent treatment and prognosis evaluation of patients.

【Key words】 LADA;  ICA;  GAD-Ab;  IAA;  diagnostic value

成人隐匿性自身免疫性糖尿病（latent autoimmune diabetes mellitus in adults，LADA）是1型糖尿病的亚型，且相较1型糖尿病，LADA患者的胰岛细胞损害速率较为缓慢。该病症早期无明显的症状体征，增加了临床误诊、漏诊风险，延误了最佳的治疗时机，对患者的生活及生存质量产生了较为严重的影响[1～2]。因此，如何有效提高LADA早期诊断的准确性，对改善患者预后具有重要的临床意义。有研究表明，胰岛素细胞抗体（insulin cell antibody，ICA）、谷氨酸脱羧酶抗体（glutamic acid decarboxylase antibody，GAD-Ab）、胰岛素自身抗体（insulin autoantibody，IAA）在LADA患者中呈现明显异常，可为临床诊断LADA患者提供新的思路与方向[3]。但目前，临床上关于该项研究的相关报道较少，致使ICA、GAD-Ab、IAA联合诊断LADA患者的价值存在争议，故本研究旨在分析ICA、GAD-Ab、IAA联合检测在LADA诊断中的应用价值，现报道如下。……