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目的:通过观察研究重庆地区1型糖尿病(type 1 diabetes mellitus,T1DM)儿童患者血清中胰岛细胞抗体(islet cell antibodies,ICA)、锌转运体8自身抗体(zinc transporter isoform 8 autoantibodies,Zn T8A)和胰岛相关自身抗体谷氨酸脱羧酶抗体(glutamic acid decarboxylase antibodies,GADA)的阳性率及其空腹C肽结果,探讨ICA、Zn T8A和GADA联合检测对1型糖尿病早期诊断的价值。方法:在我院初诊的T1DM组139例和正常组78例儿童,采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测ICA、Zn T8A和GADA;放射免疫法测定空腹C肽。T1DM组按自身抗体结果分为阳性组和阴性组。结果:1型糖尿病组的血清ICA、Zn T8A和GADA阳性率分别为61.9%(P=0.000)、51.1%(P=0.000)和54.0%(P=0.000),均明显高于正常对照组;抗体联合检测组的诊断符合率(ICA/Zn T8A=80.6%;ICA/GADA=81.6%;Zn T8A/GADA=78.3%;ICA/Zn T8A/GADA=88.9%)均高于单项抗体检测组,抗体联合检测与任一抗体单项检测的ROC曲线下面积相比均明显增大(P<0.05),3种抗体联合检测AUC=0.883(95%CI=0.830~0.936,P=0.000);抗体阳性患者的空腹C肽水平明显低于抗体阴性患者。结论:ICA、Zn T8A和GADA三者联合检测可以明显提高1型糖尿病的诊断效能。
OBJECTIVE: To observe the effects of islet cell antibodies (ICA), zinc transporter isoform 8 autoantibodies (Zn T8A), and serum creatinine (cTnA) in children with type 1 diabetes mellitus (T1DM) The positive rate of pancreatic islet-related autoantibodies glutamic acid decarboxylase antibodies (GADA) and its fasting C-peptide results were analyzed. The value of combined detection of ICA, Zn T8A and GADA in the early diagnosis of type 1 diabetes mellitus was explored. Methods: 139 patients in T1DM group and 78 normal children in our hospital were recruited. ICA, Zn T8A and GADA were detected by enzyme-linked immunosorbent assay (ELISA). The fasting C-peptide was determined by radioimmunoassay. T1DM group according to the results of autoantibodies were divided into positive group and negative group. Results: The positive rates of ICA, Zn T8A and GADA in type 1 diabetic patients were 61.9% (P = 0.000), 51.1% (P = 0.000) and 54.0% (P = 0.000), respectively, which were significantly higher than those in normal controls. The diagnostic coincidence rate (ICA / Zn T8A = 80.6%; ICA / GADA = 81.6%; Zn T8A / GADA = 78.3%; ICA / Zn T8A / GADA = 88.9%) of the combined test group was higher than that of the single antibody test group (P <0.05). The AUC was 0.883 (95% CI = 0.830-0.936, P = 0.000). The positive rate of antibody was higher than that of the other antibody Patients with fasting C-peptide levels were significantly lower than antibody-negative patients. Conclusion: The combined detection of ICA, Zn T8A and GADA can significantly improve the diagnostic efficacy of type 1 diabetes mellitus.