关键词: 糖尿病, 甲状腺疾病, 抗谷氨酸脱羧酶抗体, 甲状腺自身抗体, 影响因素分析

Abstract: Background　Autoimmune thyroid disease and autoimmune diabetes often exist simultaneously.The frequency of thyroid autoantibody（TA） is higher in autoimmune diabetes patients.Objective　To investigate the association of anti-glutamic acid decarboxylase autoantibody（anti-GADA） and TA in Chinese physical examinees.Methods　The PUMCH Health Management database was searched for physical examinees who had their anti-GADA and TA tested from 2012 to 2015.The results of anti-GADA，thyroid stimulating hormone（TSH），thyroid peroxidase antibody（TPOAb） and thyroglobulin antibody（TgAb）and other data were collected.TA positive was defined as TPOAb positive or TgAb positive.Prevalence of anti-GADA was compared between TA positive and TA negative subjects，and also between diabetic and nondiabetic subjects.Clinical characteristics were compared among subjects with anti-GADA negative，anti-GADA low titer and anti-GADA high titer.Risk factors of TA positivity，TPOAb positivity and TgAb positivity were analyzed by multivariate Logistic regression.Results　There were 36 048 eligible participants totally，among whom 5 000 （13.9%） were TA positive〔3 321（9.2%） were TPOAb positive；3 552（9.9%） were TgAb positive〕 and 31 048（86.1%） were TA negative；2 600 （7.2%） met the diagnostic criteria of diabetes and 33 448 （92.8%） did not；185 （0.5%） were anti-GADA positive and 35 863 （99.5%） were anti-GADA negative.The prevalence of anti-GADA in TA positive subjects （n=51，1.0%） was significantly higher than that in TA negative subjects （n=134，0.4%）（χ2=29.203，P<0.001）.The prevalence of TA positivity was lower in diabetic subjects（n=280，10.8%）than that in nondiabetic ones （n=4 720，14.1%）（χ2=22.558，P<0.001）.The prevalence of anti-GADA is higher in diabetic subjects（n=31，1.2%）than that in nondiabetic ones （n=154，0.5%）（χ2=25.310，P<0.001）.The frequency of TA raised from anti-GADA negative group to anti-GADA low titer group to anti-GADA high titer group （13.8%，23.7%，39.1%，respectively，P<0.05）.In the multivariate Logistic regression，age〔OR=1.015，95%CI（1.012，1.018）〕，sex〔female：OR=3.483，95%CI（3.259，3.723）〕，diabetes〔yes：OR=0.837，95%CI（0.731，0.958）〕，anti-GADA〔low titer：OR=1.900，95%CI（1.266，2.853）；high titer：OR=4.259，95%CI（2.260，8.025）〕were risk factors for presence of TA（P<0.05）.Conclusion　Anti-GADA has a low prevalence in Chinese adult physical examinees.The presence of TA is associated with GADA positivity.

Key words: Diabetes mellitus, Thyroid diseases, Glutamic acid decarboxylase autoantibody, Thyroid autoantibody, Root cause analysis