1 型糖尿病合并甲状腺疾病患者中 GADA、ZnT8A 和 IA-2A 的表达及其与甲状腺自身抗体的相关性。

Department of Clinical Laboratory, Ankang Maternal and Childcare Service Centre, Ankang, Shannxi, China.

Eur Rev Med Pharmacol Sci. 2023 Dec;27(24):12051-12057. doi: 10.26355/eurrev_202312_34803.

OBJECTIVE

The aim of this research was to study the expression of anti-glutamate decarboxylase antibody (GADA), zinc transporter-8 autoantibody (ZnT8A), and insulinoma-associated protein-2 antibody (IA-2A) in patients with type 1 diabetes (T1DM) with thyroid disease (TD) and its correlation with thyroid autoantibodies.

PATIENTS AND METHODS

380 patients with T1DM were included in the study, of which 313 patients with T1DM alone were included in the control group. In the TD group, 41 patients with T1DM and Hashimoto's thyroiditis (HT) were included, and 26 cases of T1DM patients with Graves' disease were included in the Graves group. The clinical features of the control group, the HT group, and the Graves group were compared. The positive rates of insulin autoantibodies in the control group and the TD group were analyzed. The clinical characteristics of patients with and without insulin autoantibody positivity were compared. The positive rates of thyroid autoantibodies in T1DM patients with positive GADA, ZnT8A, IA-2A, and different numbers of positive insulin autoantibodies were analyzed.

RESULTS

The levels of total cholesterol (TC) and thyroid stimulating hormone (TSH) in the HT group were significantly higher than those in the control and Graves groups, and the levels of free thyroid hormone (FT4) and low-density lipoprotein cholesterol (LDL-C) were significantly lower than those in the control and Graves groups (p<0.001). The levels of TC and TSH in the Graves group were significantly lower than those in the control group, the levels of HbA1c, LDL-C, and FT4 were significantly higher than those in the control group, and the levels of FT3 were significantly higher than those in the control and HT groups (p<0.001). The levels of C peptide, triglyceride (TG), and LDL-C of insulin autoantibodies positive patients were significantly lower than those of negative patients (p<0.05). The positive rates of GADA, ZnT8A, and IA-2A in the TD group, as well as the positive rates of double antibodies and triple antibodies, were significantly higher than those of the control group (p<0.05). In T1DM patients, the positive rates of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) in GADA and IA-2A-positive patients were significantly higher than those in GADA and IA-2A-negative patients (p<0.05). The positive rate of TPOAb in ZnT8A-positive patients was significantly higher than that in ZnT8A-negative patients (p<0.05). The positive rates of TRAb, TPOAb, and TGAb in T1DM patients positive for two of the three insulin autoantibodies and three insulin autoantibodies were significantly higher than those positive for one of the three insulin autoantibodies (p<0.001).

CONCLUSIONS

TD can exacerbate the disorder of glucose and lipid metabolism in patients with T1DM, and multiple insulin autoantibodies positive T1DM patients it is more likely to have thyroid autoantibody positivity. It is suggested that patients with aggravated glucose and lipid metabolism and multiple insulin autoantibody positivity should be routinely screened for thyroid antibodies to help early diagnosis of TD.

目的

本研究旨在探讨谷氨酸脱羧酶抗体（GADA）、锌转运蛋白-8 自身抗体（ZnT8A）和胰岛素瘤相关蛋白-2 抗体（IA-2A）在合并甲状腺疾病（TD）的 1 型糖尿病（T1DM）患者中的表达及其与甲状腺自身抗体的关系。

方法

纳入 380 例 T1DM 患者，其中 313 例 T1DM 患者为对照组。TD 组包括 41 例 T1DM 合并桥本甲状腺炎（HT）患者和 26 例 T1DM 合并格雷夫斯病（Graves）患者。比较对照组、HT 组和 Graves 组的临床特征。分析对照组和 TD 组胰岛素自身抗体的阳性率。比较胰岛素自身抗体阳性和阴性患者的临床特征。分析 GADA、ZnT8A、IA-2A 阳性及不同数量胰岛素自身抗体阳性 T1DM 患者的甲状腺自身抗体阳性率。

结果

HT 组总胆固醇（TC）和促甲状腺激素（TSH）水平明显高于对照组和 Graves 组，游离甲状腺素（FT4）和低密度脂蛋白胆固醇（LDL-C）水平明显低于对照组和 Graves 组（p<0.001）。Graves 组 TC 和 TSH 水平明显低于对照组，HbA1c、LDL-C 和 FT4 水平明显高于对照组，FT3 水平明显高于对照组和 HT 组（p<0.001）。胰岛素自身抗体阳性患者的 C 肽、三酰甘油（TG）和 LDL-C 水平明显低于阴性患者（p<0.05）。TD 组 GADA、ZnT8A 和 IA-2A 的阳性率以及双抗体和三抗体的阳性率明显高于对照组（p<0.05）。在 T1DM 患者中，GADA 和 IA-2A 阳性患者的甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TGAb）阳性率明显高于 GADA 和 IA-2A 阴性患者（p<0.05）。ZnT8A 阳性患者 TPOAb 的阳性率明显高于 ZnT8A 阴性患者（p<0.05）。三抗体阳性和两种胰岛素自身抗体阳性 T1DM 患者的 TRAb、TPOAb 和 TGAb 阳性率明显高于一种胰岛素自身抗体阳性患者（p<0.001）。