Huang Gan, Sun Guizhong, Yang Lin, Li Xia, Xiang Yufei, Zhou Zhiguang
Diabetes Center, Institute of Metabolism & Endocrinology, Second Xiangya Hospital, Key Laboratory of Diabetes Immunology, Ministry of Education, Central South University, Changsha 410011, China.
Diabetes Center, Institute of Metabolism & Endocrinology, Second Xiangya Hospital, Key Laboratory of Diabetes Immunology, Ministry of Education, Central South University, Changsha 410011, China; Email:
Zhonghua Yi Xue Za Zhi. 2015 May 26;95(20):1563-7.
To observe the changes of islet function in ZnT8A positive and IA-2A positive patients so as to provide rationales for early intervention of LADA patients.
A total of 69 outpatients and inpatients with newly diagnosed LADA testing for GADA, IA-2A and ZnT8A by radioligand binding assay (RBA) were enrolled from 2005 to 2010, including 13 with double positive for GADA and ZnT8A (GADA+ZnT8A double positive group), 14 with double positive for GADA and IA-2A (GADA+IA-2A double positive group) and 42 with positive for GADA alone (GADA positive group), 40 type 2 diabetes mellitus (T2DM) patients negative for the above three autoantibodies were selected as control subjects (T2DM group). The baseline clinical data of all groups were compared and all patients were followed annually for 3 years. Fasting plasma glucose (FBG), HbA1c, fasting C-peptide (FCP), C-peptide 2 h after meal (2 h CP), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were detected and compared among the above groups during the follow-ups.
Compared to GADA positive group and T2DM group, the GADA+IA-2A double positive group had higher level of baseline FBG and HbA1c (10.5 ± 3.6) mmol/L and (9.3 ± 2.6) % vs (9.2 ± 2.0) mmol/L and (7.4 ± 2.0) %, P = 0.017, 0.011) and had lower level of baseline FCP (415 (68-934) vs 538 (224-1 146) and 643 (163-1 658) pmol/L, P = 0.015, 0.003). During the follow-ups, FCP decreased year-on-year in GADA+ZnT8A double positive, GADA+IA-2A double positive and GADA positive groups. The annual average rate of decrease in FCP was more rapid in GADA+ZnT8A double positive and GADA+IA-2A double positive groups than those in GADA positive alone and T2DM groups (all P < 0.01).
The islet functions of newly diagnosed LADA patients with GADA and IA-2A positive are much worse. And emergence of ZnT8A and IA-2A may accelerate the failure of islet function with diabetic progress in LADA patients.
观察锌转运体8自身抗体（ZnT8A）阳性和胰岛抗原2自身抗体（IA-2A）阳性患者胰岛功能的变化，为成人隐匿性自身免疫性糖尿病（LADA）患者的早期干预提供依据。
选取2005年至2010年新诊断的LADA门诊及住院患者69例，采用放射配体结合分析法（RBA）检测谷氨酸脱羧酶自身抗体（GADA）、IA-2A和ZnT8A，其中GADA和ZnT8A双阳性者13例（GADA+ZnT8A双阳性组），GADA和IA-2A双阳性者14例（GADA+IA-2A双阳性组），单纯GADA阳性者42例（GADA阳性组）；选取40例上述三种自身抗体均阴性的2型糖尿病（T2DM）患者作为对照（T2DM组）。比较各组基线临床资料，并对所有患者进行3年的每年1次随访。随访期间检测并比较上述各组空腹血糖（FBG）、糖化血红蛋白（HbA1c）、空腹C肽（FCP）、餐后2小时C肽（2h CP）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）。
与GADA阳性组和T2DM组比较，GADA+IA-2A双阳性组基线FBG、HbA1c水平较高[（10.5±3.6）mmol/L、（9.3±2.6）%比（9.2±2.0）mmol/L、（7.4±2.0）%，P=0.017、0.011]，基线FCP水平较低[415（68-934）比538（224-1146）和643（163-1658）pmol/L，P=0.015、0.003]。随访期间，GADA+ZnT8A双阳性组、GADA+IA-2A双阳性组和GADA阳性组FCP逐年下降。GADA+ZnT8A双阳性组和GADA+IA-2A双阳性组FCP年均下降速率较单纯GADA阳性组和T2DM组更快（均P＜０.０１）。
新诊断的GADA和IA-2A阳性LADA患者胰岛功能更差。ZnT8A和IA-2A的出现可能加速LADA患者糖尿病进程中胰岛功能的衰竭。
