Ko G T, Chan J C, Yeung V T, Chow C C, Li J K, Lau M S, Mackay I R, Rowley M J, Zimmet P, Cockram C S
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, China.
Ann Clin Biochem. 1998 Nov;35 ( Pt 6):761-7. doi: 10.1177/000456329803500609.
Antibodies to glutamic acid decarboxylase (GAD) are a useful autoimmune marker for type 1 diabetes mellitus in Caucasians. We examined antibodies to GAD and their relationships with clinical features and pancreatic beta cell function in 140 young Chinese diabetic patients. Over an 18-month period beginning in 1995, 140 young Chinese diabetic subjects with age of onset of disease < or = 35 years and age < 40 years were recruited consecutively, irrespective of their modes of presentation. Clinical features, antibodies to GAD and pancreatic beta cell function (using a glucagon stimulation test) were examined. Increased levels of antibodies to GAD (> 18 units) were detected in 12.1% (n = 17) of these subjects. Forty-three (31%) patients had a classical type 1 presentation and 65 (46%) patients were insulin-deficient based on post-glucagon plasma C-peptide levels. Patients who were insulin-deficient and had a type 1 presentation had the highest prevalence of antibodies to GAD (29.0%) compared with patients who had a type 2 presentation and were non-insulin deficient (6.4%, P = 0.003). Patients who had antibodies to GAD had lower body mass index and waist-hip ratio, earlier onset of disease, lower blood pressure, plasma triglyceride and C-peptide, and higher concentrations of plasma high-density lipoprotein cholesterol and glycated haemoglobin, and were more likely to require drug treatment, compared with those without antibodies to GAD. In conclusion, there was a low prevalence of antibodies to GAD in Chinese young diabetic patients although such antibodies remained a relatively specific marker for insulin deficiency and acute presentation. Causes other than autoimmunity should be sought to explain the high prevalence of insulin deficiency in these young Chinese patients.
谷氨酸脱羧酶（GAD）抗体是白种人1型糖尿病有用的自身免疫标志物。我们检测了140例中国年轻糖尿病患者的GAD抗体及其与临床特征和胰岛β细胞功能的关系。从1995年开始的18个月期间，连续招募了140例发病年龄≤35岁且年龄＜40岁的中国年轻糖尿病患者，不论其临床表现形式。检测了临床特征、GAD抗体和胰岛β细胞功能（采用胰高血糖素刺激试验）。这些患者中12.1%（n = 17）检测到GAD抗体水平升高（＞18单位）。43例（31%）患者有典型的1型表现，65例（46%）患者根据胰高血糖素刺激后血浆C肽水平存在胰岛素缺乏。与有2型表现且非胰岛素缺乏的患者（6.4%，P = 0.003）相比，胰岛素缺乏且有1型表现的患者GAD抗体患病率最高（29.0%）。与无GAD抗体的患者相比，有GAD抗体的患者体重指数和腰臀比更低、发病更早、血压更低、血浆甘油三酯和C肽水平更低，血浆高密度脂蛋白胆固醇和糖化血红蛋白浓度更高，且更可能需要药物治疗。总之，中国年轻糖尿病患者中GAD抗体患病率较低，尽管此类抗体仍是胰岛素缺乏和急性表现的相对特异标志物。应寻找自身免疫以外的原因来解释这些中国年轻患者中胰岛素缺乏的高患病率。
