胰岛素自身免疫综合征

Insulin autoimmune syndrome

胰岛素自身免疫综合征是由血中非外源性胰岛素诱导的胰岛素自身抗体及高浓度免疫活性胰岛素所致的自发性低血糖症。其与伴发自身免疫性疾病及应用含巯基药物有关,并与人白细胞抗原高度相关,DRB1*0406可能是主要易感基因;不同人群的发病机制存在异质性。临床上主要特征为未使用外源性胰岛素情况下,出现反复发作性严重低血糖、胰岛素自身抗体滴度明显升高及游离胰岛素升高;主要应与胰岛素瘤鉴别。治疗以停用诱发药物为主,辅以少量多餐、低糖和高纤维饮食,多数患者可自行缓解。必要时应用小剂量泼尼松。

Insulin autoimmune syndrome（IAS）is a spontaneous hypoglycemia resulting from insulin autoantibudy induced by non-exogenous insulin and high concentration of immunoreactive insulin. IAS is associated with autoimmune disease and drugs containing sulphydryl group, and has a strong association with human leukocyte anfigen（HLA）, and DRB1 ＊ 0406 is considered to be the highest risk for the susceptibility to IAS. However, the mechanism of IAS could be heterogeneous in different population. IAS is characterized clinically by recurrent attacks of severe hypoglycemia, highly elevated titer of insulin autoantibody and raised free insulin without a history of using exogenous insulin. IAS should be differentiated from insulinoma. The treatment is mainly to stop using suspicions drugs, then give small and frequent meals, take a low-sugar and high-fiber diet. Most patients have spontaneons ,remission, but if it doesn＇ t, low-dose of prednisone would be necessary.