Combined detection of islet autoantibodies for clinical diagnosis of type 1 diabetes in the low-prevalence population
Combined detection of islet autoantibodies for clinical diagnosis of type 1 diabetes in the low-prevalence population
复制标题
胰岛自身抗体联合检测在低患病人群1型糖尿病临床诊断中的应用
DOI：
10.1210/clinem/dgac720
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Yong Gu
中科院分区：
文献类型：
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作者：
Yanyan Qi;Shuang Chen;Heng Chen;Yang Chen;Yun Shi;Yao Qin;Mei Zhang;Tao Yang;Yong Gu
摘要。上下文。有时在健康个体和低风险1型糖尿病（T1D）患者中检测到单一阳性的胰岛自身抗体（IAbs），被认为与糖尿病的发展无关，这使得成人发病糖尿病的诊断和分类变得困难。目标。探讨低患病率人群中抗体检测对T1D诊断的意义及临床价值；探讨电化学发光(ECL)-IAb检测法是否能提高iab在低患病率人群T1D免疫诊断中的临床应用价值。参与者和方法。将633例新诊断成人发病糖尿病患者（≥18岁）根据临床表型分为两组：575例诊断时年龄≥35岁，体重指数(BMI)≥24 kg/m2为低患病率人群（T1D低患病率人群），其余58例为高患病率人群。633名参与者的所有样品均采用标准放射结合法（RBA）和电化学发光法（ECL）平行进行抗体检测。结果。与高流行人群相比，低流行人群检测到的IAb阳性较少（94/575,16.3%比28/58,48.3%），而单一IAb阳性较多（69/94,73.4%比9/28,32.2%），其中GADA是最常见的单一IAb。在低流行人群中单iab检测并不总是提示T1D表型。通过RBA和ECL联合检测IAbs，对于区分BMI低、诊断时β细胞功能差、随访期间β细胞功能加速下降的低患病率人群中的自身免疫性糖尿病具有重要的临床应用价值。结论。RBA和ECL联合检测自身抗体可提高低患病率人群自身免疫性糖尿病与非自身免疫性糖尿病的区分。
Abstract. Context. Single positive islet autoantibodies (IAbs), sometimes detected in healthy individuals and low risk type 1 diabetes (T1D) patients, are considered to be irrelevant to the development of diabetes, making it difficult to diagnose and classify adult-onset diabetics.. Objective. To determine the significance and clinical value of IAbs in T1D diagnosis in the low-prevalence population; and to explore whether electrochemiluminescence (ECL)-IAb detection assay can improve the clinical utility of IAbs in the immunodiagnosis of T1D in the low-prevalence population.. Participants and methods. A total of 633 newly-diagnosed adult-onset diabetic patients (≥18 years old) were divided into two groups according to their clinical phenotypes: 575 patients with age at diagnosis ≥35 years and body mass index (BMI) ≥ 24 kg/m2 were considered a low-prevalence population (population with a low prevalence of T1D) and the other 58 patients were considered a high-prevalence population. All the samples from 633 participants were tested with IAbs using standard radiobinding assays (RBA) and electrochemiluminescence (ECL) assay, in parallel.. Results. Compared with the high-prevalence population, fewer positive IAbs (94/575, 16.3% vs. 28/58, 48.3%) were detected in the low-prevalence population, and more of which (69/94, 73.4% vs. 9/28, 32.2%) were positive for a single IAb, with GADA being the most prevalent single-IAb. Single-IAb detection in the low-prevalence population did not always suggest T1D phenotype. Combined detection of IAbs by RBA and ECL assays had a significant clinical utility to distinguish autoimmune diabetes in the low-prevalence population with low BMI, poor β-cell function at the diagnosis, and an accelerated decline in β-cell function during the follow-up.. Conclusions. Combined autoantibody detection by RBA and ECL assays improved differentiating autoimmune from non-autoimmune diabetes in the low-prevalence population.