Morgenthaler N G, Seissler J, Achenbach P, Glawe D, Payton M, Meinck H M, Christie M R, Scherbaum W A
Department of Internal Medicine III, University of Leipzig, Germany.
Autoimmunity. 1997;25(4):203-11. doi: 10.3109/08916939708994729.
Antibodies to the 40 kD antigen (identified as tyrosine phosphatase IA-2) and glutamate decarboxylase (GAD65) are strongly associated with insulin dependent diabetes mellitus (IDDM). However, antibodies to GAD (GADA) can appear in the absence of IDDM, particularly in stiff man syndrome (SMS) and in some individuals with autoimmune polyendocrine syndrome type II (APS II) and organ specific autoimmune diseases. The aim of this study was to compare the specificity of IA-2 antibodies (IA-2A) and GADA for IDDM by determining their frequency in different patient groups. IA-2A were present in 64/114 (56%) IDDM patients and 9/19 (47%) APS II patients with IDDM but in only 4/28 (14%) SMS patients. 1/24 (4%) APS II patients without IDDM and 1/113 (0.9%) patients with organ specific autoimmune disease had low level IA-2A. In contrast GADA were present in 77/114 (68%) IDDM patients and 17/19 (89%) APS II patients with IDDM, but also in 25/28 (89%) SMS patients, 5/24 (21%) APS II patients without IDDM and 22/113 (19%) patients with organ specific autoimmune diseases. Furthermore, within the group of new onset IDDM, IA-2A seemed to be associated with ICA and age: 63% of ICA positive IDDM patients had IA-2A (74% had GADA) increasing to 77% in the group below 20 years of age (69% for GADA). Our results demonstrate that IA-2A may be more specific for IDDM than GADA, as the latter are also present in patients with SMS, APS II without IDDM and organ specific autoimmune diseases. IA-2A were less frequent in older patients with IDDM than GADA or ICA. A combination of IA-2A and GADA detected 84% of total and 93% of ICA positive IDDM patients.
针对40kD抗原（被鉴定为酪氨酸磷酸酶IA-2）和谷氨酸脱羧酶（GAD65）的抗体与胰岛素依赖型糖尿病（IDDM）密切相关。然而，GAD抗体（GADA）可在无IDDM的情况下出现，尤其在僵人综合征（SMS）以及部分患有自身免疫性多内分泌综合征II型（APS II）和器官特异性自身免疫性疾病的个体中。本研究的目的是通过测定不同患者组中IA-2抗体（IA-2A）和GADA的频率来比较它们对IDDM的特异性。IA-2A存在于64/114（56%）的IDDM患者和9/19（47%）患有IDDM的APS II患者中，但仅在4/28（14%）的SMS患者中出现。1/24（4%）无IDDM的APS II患者和1/113（0.9%）患有器官特异性自身免疫性疾病的患者有低水平的IA-2A。相比之下，GADA存在于77/114（68%）的IDDM患者和17/19（89%）患有IDDM的APS II患者中，也存在于25/28（89%）的SMS患者、5/24（21%）无IDDM的APS II患者以及22/113（19%）患有器官特异性自身免疫性疾病的患者中。此外，在新诊断的IDDM组中，IA-2A似乎与胰岛细胞抗体（ICA）和年龄有关：63%的ICA阳性IDDM患者有IA-2A（74%有GADA），在20岁以下组中增至77%（GADA为%）。我们的结果表明，IA-2A对IDDM可能比GADA更具特异性，因为后者也存在于SMS患者、无IDDM的APS II患者和器官特异性自身免疫性疾病患者中。在年龄较大的IDDM患者中，IA-2A的频率低于GADA或ICA。IA-2A和GADA联合检测出84%的IDDM患者以及93%的ICA阳性IDDM患者。
