Eiji Kawasaki, Toshiyuki Ikeoka, Department of Metabolism/Diabetes and Clinical Nutrition, Nagasaki University Hospital, Nagasaki 852-8501, Japan.
World J Diabetes. 2013 Oct 15;4(5):227-30. doi: 10.4239/wjd.v4.i5.227.
We have previously reported the high levels of glutamic acid decarboxylase 65 autoantibodies (GAD65A) in patients with type 1 diabetes and autoimmune thyroid disease. Here we describe a 32-year-old Japanese female with a thirteen-year history of type 1 diabetes whose levels of GAD65A were elevated just after the emergence of anti-thyroid autoimmunity. At 19 years of age, she developed diabetic ketoacidosis and was diagnosed with type 1 diabetes. She had GAD65A, insulinoma-associated antigen-2 autoantibodies (IA-2A), and zinc transporter-8 autoantibodies (ZnT8A), but was negative for antibodies to thyroid peroxidase (TPOAb) and thyroglobulin (TGAb) at disease onset. ZnT8A and IA-2A turned negative 2-3 years after the onset, whereas GAD65A were persistently positive at lower level (approximately 40 U/mL). However, just after the emergence of TGAb at disease duration of 12.5 years, GAD65A levels were reelevated up to 5717 U/mL in the absence of ZnT8A and IA-2A. Her thyroid function was normal and TPOAb were consistently negative. She has a HLA-DRB1*03:01/04:01-DQB102:01/*03:02 genotype. Persistent positivity for GAD65A might be associated with increased risk to develop anti-thyroid autoimmunity.
我们之前曾报道过 1 型糖尿病和自身免疫性甲状腺疾病患者谷氨酸脱羧酶 65 自身抗体（GAD65A）水平较高。在这里，我们描述了一位 32 岁的日本女性，她患有 13 年的 1 型糖尿病，在自身免疫性甲状腺疾病出现后不久，GAD65A 水平升高。19 岁时，她出现糖尿病酮症酸中毒，并被诊断为 1 型糖尿病。她有 GAD65A、胰岛素瘤相关抗原-2 自身抗体（IA-2A）和锌转运蛋白-8 自身抗体（ZnT8A），但在发病时对甲状腺过氧化物酶（TPOAb）和甲状腺球蛋白（TGAb）抗体呈阴性。ZnT8A 和 IA-2A 在发病后 2-3 年内转为阴性，而 GAD65A 则持续呈低水平阳性（约 40 U/mL）。然而，就在发病 12.5 年后 TGAb 出现后，GAD65A 水平再次升高至 5717 U/mL，此时没有 ZnT8A 和 IA-2A。她的甲状腺功能正常，TPOAb 持续阴性。她具有 HLA-DRB1*03:01/04:01-DQB102:01/*03:02 基因型。GAD65A 的持续阳性可能与发生抗甲状腺自身免疫的风险增加有关。
