Sodoyez J C, Koch M, Sodoyez-Goffaux F
Service d'Endocrinologie CHU, Université de Liège, Belgique.
Diabete Metab. 1991 Mar-Apr;17(2):255-69.
Anti-insulin antibodies detection is based on the demonstration of a specific and saturable binding to insulin either radiolabelled with 125 I (Radiobinding assay or RBA) or coated on a solid phase (Enzyme linked immunosorbent assay or EIA). The 2 assays are remarkably different by their sensitivity to the affinity of the antigen antibody reaction. In addition, RBA may be biased by the presence of the iodine atom on the radioiodinated insulin whereas, at least on theoretical grounds. EIA could be biased because of denaturation or non availability of some epitopes when insulin is coated. Anti-insulin antibodies may be induced by insulin therapy. When they "spontaneously" appear, they are called autoantibodies. Insulin autoantibodies may be detected in the normal population, in type 1 diabetic patients before any administration of exogenous insulin and in patients suffering from the autoimmune hypoglycemic syndrome. In some patients, this syndrome may be associated with administration of a thiol containing drug. In some cases, insulin antibodies may appear several years after a transient insulin therapy, possibly as a consequence of a disturbance of the immunologic memory. The properties of antibodies and autoantibodies (concentration, affinity, number and nature of epitopes, heavy and light chain composition and ability to form aggregates) are relatively characteristic of the disease with which they are associated and determine their potential effects on insulin bioavailability and plasma glucose homeostasis.
抗胰岛素抗体检测基于与胰岛素特异性且可饱和结合的证明，胰岛素可通过用125I进行放射性标记（放射结合测定法或RBA）或包被在固相上（酶联免疫吸附测定法或EIA）。这两种测定法在对抗原抗体反应亲和力的敏感性方面有显著差异。此外，RBA可能会受到放射性碘化胰岛素上碘原子存在的影响，而至少从理论上讲，当胰岛素包被时，EIA可能会因某些表位的变性或不可用而受到影响。抗胰岛素抗体可能由胰岛素治疗诱导产生。当它们“自发”出现时，被称为自身抗体。在正常人群、1型糖尿病患者在任何外源性胰岛素给药之前以及患有自身免疫性低血糖综合征的患者中都可以检测到胰岛素自身抗体。在一些患者中，这种综合征可能与含硫醇药物的给药有关。在某些情况下，胰岛素抗体可能在短暂的胰岛素治疗数年后出现，这可能是免疫记忆紊乱的结果。抗体和自身抗体的特性（浓度、亲和力、表位的数量和性质、重链和轻链组成以及形成聚集体的能力）相对具有与其相关疾病的特征，并决定了它们对胰岛素生物利用度和血浆葡萄糖稳态的潜在影响。
