A Meta-analysis Of The Diagnostic Efficacy Of Autoimmune Antibodies In Latent Autoimmune Diabetes In Adults

Objective:Autoimmune type 1 diabetes mellitus,according to the severity of acute onset and rapid onset,the latter in adult morbidity is also known as adult occult autoimmune diabetes(latent autoimmune diabetes in adults LADA),China's LADA patients in the world The incidence of LADA patients with the new type 2 diabetes is very similar,but the treatment is not the same,some experts stressed that LADA treatment of the "window period",as soon as possible the use of low-dose insulin treatment LADA,Reduce beta cell activity,reduce inflammation.Clinical diagnosis of LADA is poor,and LADA has been no uniform diagnostic criteria,and now the general diagnostic criteria for the 2012 China Diabetes Branch to develop the standard: 1.age ? 18 years of age onset;2.insulin autoantibody positive;3 at least 6 months after diagnosis without insulin treatment.And age and progress to the time of insulin dependence is relatively uncertain,so the maximum clinical significance of insulin autoantibodies,but so far there is no clear antibody recommended.To evaluate the diagnostic value of GADA?ICA?IAA?and ZNT8 A in adult autoimmune diabetes mellitus.Methods:To establish the relevant inclusion and exclusion criteria,according to the standard search Pub Med,Medline,EMbase,Cochrane Library,Wanfang database,Weipu,CNKI,China Hospital Knowledge Base,1997-2017 related literature screening,the use of meta-Disc calculation of heterogeneity And the combined sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic ratio ratio,Rev Man 5.3 software to draw the funnel test bias.Results:A total of 19 studies were included,of which 9 were Chinese and 10 were foreign(Table 1).15 of which were related to GADA,5 related to ICA,6 related to IAA,6 related too ZNT8 A,7 related to GADA+ICA+IAA,.a total of 5 articles is GADA+ICA+IAA+ZNT8A.The sensitivity of several antibodies in LADA was GADA + ICA + IAA + ZNT8A> GADA + ICA + IAA> GADA> ICA = ZNT8A> IAA,and the specificity was from high to low ICA> IAA> GADA> GADA + ICA + IAA> GADA + ICA + IAA + ZNT8A> ZNT8 A,diagnostic ratio ratio from high to low GADA + ICA + IAA + ZNT8A> ICA> GADA + ICA + IAA> IAA> GADA> ZNT8 A.SROC area(AUC)The best sensitivity specificity positions are GADA 0.75,ICA 0.91,IAA 0.72,ZNT8 A 0.75,GADA + ICA + IAA 0.82,and the best sensitivity specificity positions are GADA + ICA + IAA + ZNT8A> ICA> GADA + ICA + IAA> GADA = ZNT8A> IAA,GADA + ICA + IAA + ZNT8 A 0.91.Conclusion:After the statistical analysis of software,the highest sensitivity of single antibody was GADA,the highest specific antibody was ICA.However,it was not the same as the combination of antibody diagnosis,the diagnosis of four kinds of antibodies,the sensitivity was greatly improved,the diagnostic efficiency was the biggest.Antibody detection can improve the detection rate,can reduce the rate of missed diagnosis,and the specificity is relatively high,it is recommended suspicious newly diagnosed type 2 diabetes screening antibody,it is recommended to jointly detect the higher sensitivity of antibodies(GADA + ICA + IAA + ZNT8A),improve the detection rate of LADA patients,early treatment of LADA patients,the protection of pancreatic ? cells,delayed pancreatic damage progress.