Hoeldtke R D, Bryner K D, Horvath G G, Byerly M R, Hobbs G R, Marcovina S M, Lernmark A
Department of Medicine, West Virginia University, Morgantown 26506-9159, USA.
Diabetes Care. 1997 Dec;20(12):1900-3. doi: 10.2337/diacare.20.12.1900.
To analyze the effect of antibodies to glutamic acid decarboxylase (GAD65Ab) and islet cells (ICA512Ab) on glycemic control early in IDDM.
GAD65Ab and ICA512Ab were measured twice in 35 patients (10 male, 25 female; age 10-40 years) initially within 2 years of diagnosis and again 1 year later. The glycosylated hemoglobin was measured one to four times each year, and the average glycosylated hemoglobin for the preceding year was calculated each time the antibodies were measured.
The mean HbA1 at the time of the initial evaluation was 8.04 +/- 0.30 (reference range 4.7-7.3% for nondiabetic patients), the average GAD65Ab index was 0.735 +/- 0.306, and the mean ICA512Ab index was 1.94 +/- 0.65. The GAD65Ab index correlated with HbA1 (r = 0.41, P < 0.025), whereas the ICA512Ab index did not (r = 0.13). One year later, the mean GAD65Ab index was 0.94 +/- 0.34, the mean ICA512Ab index was 1.04 +/- 0.40, and the mean HbA1 was 9.03 +/- 0.30. The GAD65Ab index correlated with HbA1 (r = 0.61 P < 0.001), whereas the ICA512Ab index did not (r = -0.06). Stratification of patients into tertiles according to the average GAD65 index revealed, at the follow-up evaluation, that the better glycemic control in the lowest GAD65Ab tertile was accomplished with significantly less insulin (0.43 +/- 0.08 U/kg for the lowest tertile vs. 0.71 +/- 0.09 and 0.64 +/- 0.09 for the middle and highest tertiles, respectively; P < 0.05).
In summary, patients with IDDM and low GAD65Ab have better glycemic control even though they require less insulin. The ICA512Ab index, however, fails to correlate with glycemia.
分析谷氨酸脱羧酶抗体（GAD65Ab）和胰岛细胞抗体（ICA512Ab）对胰岛素依赖型糖尿病（IDDM）早期血糖控制的影响。
对35例患者（10例男性，25例女性；年龄10 - 40岁）在确诊后的最初2年内进行两次GAD65Ab和ICA512Ab检测，1年后再次检测。每年检测糖化血红蛋白1至4次，每次检测抗体时计算前一年的糖化血红蛋白平均值。
初始评估时糖化血红蛋白（HbA1）的平均值为8.04±0.30（非糖尿病患者的参考范围为4.7 - 7.3%），GAD65Ab指数的平均值为0.735±0.306，ICA512Ab指数的平均值为1.94±0.65。GAD65Ab指数与HbA1相关（r = 0.41，P < 0.025），而ICA512Ab指数与HbA1不相关（r = 0.13）。1年后，GAD65Ab指数的平均值为0.94±0.34，ICA512Ab指数的平均值为1.04±0.40，HbA1的平均值为9.03±0.30。GAD65Ab指数与HbA1相关（r = 0.61，P < 0.001），而ICA512Ab指数与HbA1不相关（r = -0.06）。根据GAD65平均指数将患者分为三分位数，在随访评估中发现，最低GAD65Ab三分位数组的血糖控制较好，且所需胰岛素显著较少（最低三分位数组为0.43±0.08 U/kg，中间和最高三分位数组分别为0.71±0.09和0.64±0.09；P < 0.05）。
总之，IDDM且GAD65Ab水平低的患者即使所需胰岛素较少，血糖控制也较好。然而，ICA512Ab指数与血糖不相关。
