Islet cell antibodies and glutamic acid decarboxylase antibodies, but not the clinical phenotype, help to identify type 11/2 diabetes in patients presenting with type 2 diabetes
Islet cell antibodies and glutamic acid decarboxylase antibodies, but not the clinical phenotype, help to identify type 11/2 diabetes in patients presenting with type 2 diabetes
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DOI：
10.1053/meta.2001.25654
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发表时间：
2001-09-01
影响因子：
9.8
通讯作者：
Palmer, JP
中科院分区：
文献类型：
--
作者：
Juneja, R;Hirsch, IB;Palmer, JP
本研究旨在确定哪些 1 型糖尿病相关自身抗体以及哪些临床特征对于识别 1 1/2 型糖尿病患者最有用。我们研究了 125 名最近临床诊断为 2 型糖尿病的患者，他们是否存在胰岛细胞抗体 (ICA)、胰岛素自身抗体 (IAA)、谷氨酸脱羧酶抗体 (GADAb) 和 IA-2a (IA-2Ab)。研究对象为诊断时符合以下所有标准的 2 型糖尿病患者：年龄大于或等于 30 岁、无酮尿或酮症酸中毒病史、不需要胰岛素治疗。 36 名患者 (29%) 至少有 1 种抗体呈阳性。 32 例 (26%) ICA 阳性，20 例 (16%) GADAb 阳性。胰岛素自身抗体和 IA-2Ab 的出现频率分别较低，分别为 2 名 (1.6%) 和 8 名 (6.4%) 患者。 Ab(+) 和 Ab(-) 患者的诊断年龄没有显着差异，年龄（范围）分别为 47.2 岁（32 至 64 岁）和 51.2 岁（31 至 77 岁），P = .06。两组的体重指数 (BMI) 不同，Ab(+) 患者肥胖程度较低，BMI（范围）分别为 28.3 kg/m(2)（17.6 至 54.9）与 32.0 kg/m(2)（19.2 至 68.8），P = .01。 Ab(+) 患者的糖尿病临床表现更常见为多尿和多饮症状，而 Ab(-) 患者则更常偶然诊断，P = .002。然而，无论抗体状态如何，超过 95% 的患者在年龄和 BMI 上都有重叠。同样，42％的 Ab（+）患者偶然被诊断出糖尿病，而 29％的 Ab（-）患者则出现多尿和多饮。因此，我们得出结论，应使用抗体（主要是 ICA 和 GAD）筛查，而不是年龄、BMI 或临床表现来识别 1 1/2 型糖尿病。版权所有 (C) 2001 W.B.桑德斯公司。
This study was undertaken to determine which type 1 diabetes-associated autoantibodies and what clinical characteristics are most useful to identify patients with type 1 1/2 diabetes. We studied 125 patients, recently diagnosed clinically with type 2 diabetes for the presence of islet cell antibodies (ICA), insulin autoantibodies (IAA), antibodies to glutamic acid decarboxylase(GADAb), and IA-2a (IA-2Ab). Patients with a diagnosis of type 2 diabetes who met all of the following criteria at diagnosis were studied: age greater than or equal to 30 years, no history of ketonuria or ketoacidosis, and not requiring insulin treatment. Thirty-six patients (29%) were positive for at least 1 antibody. Thirty-two (26%) were ICA positive and 20 (16%) GADAb positive. Insulin autoantibodies and IA-2Ab occurred less frequently in 2 (1.6%) and 8 (6.4%) patients, respectively. There was no significant difference in the ages at diagnosis between the Ab(+) and Ab(-) patients, age in years (range) 47.2 (32 to 64) versus 51.2 (31 to 77), respectively, P = .06. Body mass index (BMI) was different in the 2 groups, with Ab(+) patients being less obese, BMI (range) 28.3 kg/m(2) (17.6 to 54.9) versus 32.0 kg/m(2) (19.2 to 68.8), respectively, P = .01. Clinical presentation of diabetes was more commonly symptomatic with polyuria and polydipsia in Ab(+) patients, while in Ab(-) patients, diagnosis was more often incidental, P = .002. However, more than 95% of patients overlapped in both age and BMI irrespective of antibody status. Similarly, 42% of Ab(+) patients had their diabetes diagnosed incidentally, while 29% of Ab(-) patients presented with polyuria and polydipsia. We therefore conclude that screening with antibodies, mainly ICA and GAD, but not age, BMI, or clinical presentation should be used to identify type 1 1/2 diabetes. Copyright (C) 2001 by W.B. Saunders Company.