刘丽雅　方跃亭　洪清楚

[摘要] 目的 探讨胰岛素抗体在I型糖尿病（T1DM）和2型糖尿病（T2DM）患者的临床分型诊断中的价值。方法 选取该院于2015年6月—2017年6月收治的100例糖尿病患者作为研究对象，其中I型40例，2型60例。比较不同分型糖尿病患者的胰岛素抗体水平以及相关生化指标的状态。结果 INS-Ab阳性组、阴性组患者餐后2 h的INS、CP水平均显著增加，其中阳性组餐后2 h的INS显著高于INS-Ab阴性组患者；I型糖尿病患者的胰岛自身抗体（ IAA-Ab、ICA-Ab 以及GAD-Ab）阳性率均明显高于2型糖尿病患者，且I型糖尿病患者的3种抗体联合检测时的阳性率显著高于单项检测，差异有统计学意义（P<0.05）。结论 糖尿病患者血清中的胰岛素抗体阳性率的检测对T1DM与T2DM的临床分型诊断有一定的指导价值，有利于对糖尿病的正确分型、早期预测，提供有效依据。

[关键词] 胰岛素抗体；I型糖尿病；2型糖尿病

[中图分类号] R587.1 [文献标识码] A [文章编号] 1672-4062（2018）02（a）-0027-03

Clinical Significance of Insulin Antibody on the Classification of Diabetes

LIU Li-ya， FANG Yue-ting， HONG Qing-chu

Department of Clinical Laboratory， Xiamen Fifth Hospital， Xiamen， Fujian Province， 361101 China

[Abstract] Objective To study the value of insulin antibody in the clinical typing diagnosis of T1DM and T2DM. Methods 100 cases of diabetes patients admitted and treated in our hospital from June 2015 to June 2017 were selected and divided into two groups， including 40 cases with type I diabetes and 60 cases with type 2 diabetes， and the insulin antibody level and related biochemical indicators were compared between the two groups. Results The postprandial 2 hINS and CP levels in the INS-Ab positive group and negative group obviously increased， and the postprandial 2 hINS in the positive group was obviously higher than that of INS-Ab negative group， and the insulin antibody of patients with type I diabetes IAA-Ab， ICA-Ab and GAD-Ab was obviously higher than that of patients with type 2 diabetes， and the combined test positive rate of patients with type I diabetes was obviously higher than that of single test， and the difference was statistically significant（P<0.05）. Conclusion The test of insulin antibody positive rate in serum of diabetes patients has a certain guidance value in the clinical classification diagnosis of T1DM and T2DM， which is conductive to the accurate typing and early predication of diabetes， thus providing effective reference.

[Key words] Insulin antibody； Type I diabetes； Type 2 diabetes

糖尿病（diabetes mellitus） 是以高糖血癥、糖代谢紊乱为主要特征的慢性代谢性疾病[1]，临床主要症状为“三多一少”，可分为T1DM、T2DM以及妊娠型糖尿病等类型，其中以T1DM、T2DM最为常见。T1DM是由于患者自身胰岛β细胞损坏而导致胰岛素分泌绝对不足所致，需要终生使用胰岛素维持正常血糖[2]。T2DM则是由于胰岛素抵抗（insulin resistance，IR）而导致胰岛素分泌相对不足所致，通常不需要依赖胰岛素维持正常血糖。患者不管是在长期使用外源性胰岛素或者胰岛素类似物治疗过程中，还是血中自身胰岛素的诱导，都可以产生胰岛素抗体（ insulin antibody，IAb），引起IR，血糖大幅度波动，降低治疗效率。而临床上针对糖尿病患者胰岛素抗体的治疗，根据患者病程病况、生命体征、经济状况以及临床治疗效果，选择合适的治疗方案至关重要，包括更换胰岛素制剂，合理选用口服降糖药（双胍类、磺胺类、GLP-1受体激动剂等），使用类固醇激素或免疫抑制剂，或者进行血浆置换等治疗[3]。……