1例胰岛素自身抗体所致频发严重低血糖的糖尿病患者的循证治疗

Evidence-Based Treatment of Hypoglycemia in A Diabetic Patient with Insulin Autoantibody

目的针对近期收治的1例少见胰岛素自身抗体(insulin autoantibody,IAA)所致频发严重低血糖的糖尿病患者,检索当前最佳证据,为临床合理治疗提供依据。方法计算机检索Cochrane图书馆(2008年第3期)、PubMed(1966～2009.7)、EMbase(1974～2009.7)、CBM(1978～2009.7)、CNKI(1976～2009.7),按证据级别高低查找相关证据,并对所获证据进行评价。结果共检索到291篇文献,无临床指南和系统评价,也无临床对照研究。有关临床治疗的文献共有30篇,共包括6种治疗措施,其中胰岛素联合类固醇类药物效果相对较好,副作用发生较低。根据患者意愿和我院实际情况,在应用胰岛素控制血糖的基础上,对该患者短期给予糖皮质激素(强的松)治疗,17天后IAA滴度从13.3%降至5.41%,24天后降至0.62%,血糖水平趋于稳定,未见低血糖发生。随访5个月,病情稳定,血糖控制尚可,未见低血糖发作。结论短期给予糖皮质激素治疗是治疗IAA所致频发严重低血糖的有效方法。

Objective To identify the best therapy regimen for a patient with rare hypoglycemia due to insulin autoantibody（IAA）.Methods We searched The Cochrane Library（Issue 3,2008）,PubMed（1966-July 2009）,EMbase（1974-July 2009） and CBM（1978-July 2009） to identify relevant evidence.The quality of the retrieved studies was critically assessed.Results A total of 291 records were retrieved.No clinical guidelines,systematic reviews or clinical randomized studies were identi ed.Thirty treatment-related studies involving 6 interventions showed that insulin combined with Prednisone was relatively more e ective and safer than conventional therapies.Conclusion The steroid treatment might be useful for the improvement of glycamic control in patients with high IAA levels and severe hypoglycemia and hyperglycemia due to insulin antibodies raised against subcutaneously-injected human insulin.