Departments of Internal Medicine and Diabetology.
Eur J Endocrinol. 2014 Mar 14;170(4):651-8. doi: 10.1530/EJE-13-0901. Print 2014 Apr.
The diagnosis of autoimmune diabetes in non-obese adults is based on the detection of glutamic acid decarboxylase autoantibodies (GADA), islet cell antibodies (ICA) and antibodies to tyrosine phosphatase (IA-2A). Zinc transporter 8 (ZnT8) has been identified as a new autoantigen in patients with type 1 diabetes mellitus. The coincidence of autoimmune thyroiditis (AITD) with diabetes is common; therefore, screening of TSH and thyroid peroxidase antibodies (ATPO) is recommended during the diagnosis of diabetes. In this study, we determined whether the occurrence of islet autoantibodies is associated with a positive titre of ATPO in newly diagnosed adult-onset autoimmune diabetic patients.
THE STUDY INVOLVED 80 NON-OBESE ADULTS AGED 44 (INTERQUARTILE RANGE (IQR): 37-51) years with a BMI of 24.0 (IQR: 22.2-26.0) kg/m(2) and new-onset diabetes. The markers of autoimmune diabetes (GADA, ICA, IA-2A and ZnT8A), TSH and thyroid peroxidase antibodies (ATPO) were evaluated.
IN THE STUDY POPULATION, 70% (N=56) OF THE SUBJECTS WERE POSITIVE FOR AT LEAST ONE OF THE FOUR ASSESSED MARKERS OF AUTOIMMUNE DIABETES (83.9% GADA, 62.5% ICA, 42.8% IA-2A AND 33% ZNT8A) AND 37.5% OF THE SUBJECTS WERE POSITIVE FOR ATPO. THE ZNT8A-POSITIVE SUBJECTS HAD HIGHER ATPO TITRES THAN THE ZNT8A-NEGATIVE SUBJECTS (172.7 (IQR: 0.36-410.4) vs 92.4 (IQR: 0-23.7) IU/ml, P=0.001). Based on the assessed islet autoantibodies, the occurrence of positive ZnT8A and GADA was found to be related to a positive titre of ATPO using logistic regression (OR=5.48, 95% CI: 1.65-18.14, P=0.006 and OR=3.42, 95% CI: 1.09-10.71, P=0.03 respectively).
In non-obese adults with new-onset diabetes, the presence of GADA and especially ZnT8 autoantibodies increases the risk of AITD.
在非肥胖的成年人群中，自身免疫性糖尿病的诊断基于谷氨酸脱羧酶自身抗体（GADA）、胰岛细胞抗体（ICA）和酪氨酸磷酸酶自身抗体（IA-2A）的检测。锌转运蛋白 8（ZnT8）已被确定为 1 型糖尿病患者的新自身抗原。自身免疫性甲状腺炎（AITD）与糖尿病同时发生较为常见；因此，建议在诊断糖尿病时同时筛查促甲状腺激素和甲状腺过氧化物酶抗体（ATPO）。在本研究中，我们确定了新诊断的成年起病自身免疫性糖尿病患者中胰岛自身抗体的发生是否与 ATPO 的阳性滴度相关。
该研究共纳入 80 名非肥胖的成年患者，年龄为 44 岁（四分位距（IQR）：37-51），BMI 为 24.0（IQR：22.2-26.0）kg/m²，且为新发糖尿病。评估了自身免疫性糖尿病的标志物（GADA、ICA、IA-2A 和 ZnT8A）、促甲状腺激素和甲状腺过氧化物酶抗体（ATPO）。
在研究人群中，70%（N=56）的受试者至少有 4 种自身免疫性糖尿病评估标志物中的一种为阳性（83.9% GADA、62.5% ICA、42.8% IA-2A 和 33% ZnT8A），且 37.5%的受试者 ATPO 阳性。与 ZnT8A 阴性的受试者相比，ZnT8A 阳性的受试者 ATPO 滴度更高（172.7（IQR：0.36-410.4）vs 92.4（IQR：0-23.7）IU/ml，P=0.001）。基于评估的胰岛自身抗体，使用逻辑回归发现阳性 ZnT8A 和 GADA 的发生与 ATPO 的阳性滴度相关（OR=5.48，95%CI：1.65-18.14，P=0.006 和 OR=3.42，95%CI：1.09-10.71，P=0.03）。
在新发糖尿病的非肥胖成年人群中，GADA 的存在，尤其是 ZnT8 自身抗体的存在，增加了发生 AITD 的风险。
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