本文關(guān)鍵詞： 成人隱匿性自身免疫性糖尿病 谷氨酸脫羧酶抗體 胰島細(xì)胞抗體 胰島素自身抗體 鋅轉(zhuǎn)運(yùn)抗體8自身抗體 meta分析　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:自身免疫性1型糖尿病,按起病急緩分為急發(fā)型和緩發(fā)型,后者在成人發(fā)病時(shí)又稱為成人隱匿性自身免疫性糖尿病(latent autoimmu ne diabetes in adults LADA),我國(guó)LADA患者在全世界地區(qū)也有較高發(fā)病率,而LADA患者的癥狀與新發(fā)的2型糖尿病極其相似,但在治療上卻不相同,現(xiàn)有些專家強(qiáng)調(diào)LADA治療的“窗口期”,盡早使用小劑量胰島素治療LADA,減少β細(xì)胞活動(dòng),減少炎癥反應(yīng)。臨床上L ADA的診斷率卻差強(qiáng)人意,可能與LADA一直沒(méi)有統(tǒng)一的診斷標(biāo)準(zhǔn)有關(guān),現(xiàn)在通用的診斷標(biāo)準(zhǔn)是2012年中華糖尿病分會(huì)制定的標(biāo)準(zhǔn):1.年齡≥18歲起病;2.胰島素自身抗體陽(yáng)性;3.診斷后至少6個(gè)月無(wú)需胰島素治療。而年齡和進(jìn)展到胰島素依賴的時(shí)間相對(duì)不確定,所以胰島素自身抗體臨床意義最大,但是至今未有明確的抗體推薦。系統(tǒng)評(píng)價(jià)成人隱匿性自身免疫性糖尿病自身抗體谷氨酸脫羧酶(GADA)、胰島細(xì)胞抗體(ICA)、胰島素自身抗體(IAA)和鋅轉(zhuǎn)運(yùn)抗體-8(ZNT8)的診斷價(jià)值。方法:制定相關(guān)納入和排除標(biāo)準(zhǔn),根據(jù)標(biāo)準(zhǔn)檢索Pub Med、Medline、E Mbase、Cochrane圖書館、萬(wàn)方數(shù)據(jù)庫(kù)、維普、CNKI等數(shù)據(jù)庫(kù),1997-2017相關(guān)文獻(xiàn)進(jìn)行篩選,利用meta-Disc計(jì)算異質(zhì)性及合并敏感度、特異度、陽(yáng)性似然比、陰性似然比及診斷比值比,Rev Man 5.3軟件繪制漏斗圖檢驗(yàn)偏倚。結(jié)果:納入19篇文獻(xiàn),其中中文文獻(xiàn)9篇,外文文獻(xiàn)10篇(表1)。其中GADA相關(guān)文獻(xiàn)15篇,ICA相關(guān)文獻(xiàn)5篇,IAA相關(guān)文獻(xiàn)6篇,ZNT8A相關(guān)文獻(xiàn)6篇,GADA+ICA+IAA聯(lián)合診斷相關(guān)7篇,GADA+ICA+IAA+ZNT8A相關(guān)5篇。診斷LADA的幾種抗體靈敏度由高到低分別為GA DA+ICA+IAA+ZNT8AGADA+ICA+IAAGADAICA=ZNT8AIA A,特異度由高到低分別為ICAIAAGADAGADA+ICA+IAAGAD A+ICA+IAA+ZNT8AZNT8A,診斷比值比由高到低GADA+ICA+IA A+ZNT8AICAGADA+ICA+IAAIAAGADAZNT8A.SROC面積(AUC)依次為GADA+ICA+IAA+ZNT8AICAGADA+ICA+IAAGADA=ZNT8AIAA,最佳靈敏度特異度位置依次為GADA 0.75,I CA 0.91,IAA 0.72,ZNT8A 0.75,GADA+ICA+IAA 0.82,GADA+ICA+IAA+ZNT8A 0.91。結(jié)論:經(jīng)過(guò)統(tǒng)計(jì)學(xué)軟件分析,單一抗體靈敏度最高為GADA,特異度最高抗體為ICA,然而均不及聯(lián)合抗體診斷,聯(lián)合四種抗體診斷,靈敏度大大提高,診斷效能最大�？贵w聯(lián)合檢測(cè)可提高檢出率,可以減少漏診率,而特異度也是相對(duì)較高的,所以建議可疑的初診2型糖尿病患者篩查抗體,建議聯(lián)合檢測(cè)靈敏度較高的抗體(GADA+ICA+IAA+ZNT8A),提高LADA患者檢出率,提早治療LADA患者,保護(hù)胰腺β細(xì)胞,延緩胰腺損壞進(jìn)展。
[Abstract]:Objective: autoimmune type 1 diabetes mellitus is divided into acute onset and slow onset according to the onset of the disease. The latter is also called latent autoimmu ne diabetes in adults LADAA in adult. The incidence of LADA in China is also high in the world, and the symptoms of LADA patients are very similar to those of new type 2 diabetes mellitus. However, the treatment is different. Now some experts emphasize the "window period" of LADA treatment, using small dose insulin as early as possible to treat Lada, reduce the activity of 尾 cells and reduce inflammatory reaction. The diagnostic rate of LADA in clinic is not satisfactory. It may have something to do with the fact that there has been no uniform diagnostic criteria for LADA, The current universal diagnostic criteria are those formulated by the Chinese Diabetes Society in 2012: 1. Age 鈮，

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