High levels of antigen-specific islet antibodies predict future β-cell failure in patients with onset of diabetes in adult age

被引:66
作者
Borg, H
Gottsäter, A
Landin-Olsson, M
Fernlund, P
Sundkvist, G
机构
[1] Lund Univ, Wallenberg Lab, Malmo Univ Hosp, Dept Endocrinol, SE-20502 Malmo, Sweden
[2] Lund Univ, Malmo Univ Hosp, Dept Vasc Dis, SE-20502 Malmo, Sweden
[3] Lund Univ, Malmo Univ Hosp, Dept Clin Chem, SE-20502 Malmo, Sweden
[4] Univ Lund Hosp, Dept Med, SE-22185 Lund, Sweden
关键词
D O I
10.1210/jc.86.7.3032
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
It is unclear whether high levels of antigen-specific islet antibodies [GADA (glutamic acid decarboxylase 65 antibodies) and IA2-ab (protein tyrosine phosphatase-like protein antibodies)] predict beta -cell failure in patients with onset of diabetes in adult age. Therefore, GADA and IA2-ab levels at the diagnosis of diabetes were related to fasting plasma C-peptide levels 5 yr later in 148 patients with diabetes onset in adult age (age at onset, 20-77 yr; median, 57 yr). Classical islet cell antibodies (ICA) were also determined. Complete beta -cell failure (undetectable fasting plasma C-peptide) was only present in 4 patients at diagnosis of diabetes, but in 21 patients 5 yr thereafter. At diagnosis,ICA were detected in 20 of 21 (95%) patients with beta -cell failure after 5 yr and in only 7 of 127 (5%) without, whereas GADA and/or IA2-ab (> 91.5 percentile of healthy controls) were detected in all 21 (100%) with but also in 23 of 127 (18%) patients without beta -cell failure after 5 yr. Thus, ICA had a higher positive predictive value (74%) than GADA and/or IA2-ab (47%; P < 0.05). With high cutoff Values for GADA and IA2-ab, however, GADA and/or IA2-ab were detected in 19 of 21 (90%) patients with p-cell failure us. only in 5 of 127 (4%) without, giving a positive predictive value of 79%. Slightly elevated GADA levels in IA2-ab-negative patients were associated with progressive but not complete beta -cell failure within the study period. Hence, high GADA and/or IA2-ab levels predict a future complete beta -cell failure, whereas low GADA levels predict slowly progressive beta -cell insufficiency.
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页码:3032 / 3038
页数:7
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