胰岛素自身免疫综合征合并Graves病1例及文献分析

Insulin autoimmune syndrome in a patient with Graves＇ disease and literatures review

胰岛素自身免疫综合征（IAS）是指从未使用过胰岛素的患者发生的严重自发性低血糖，由遗传因素和环境因素共同作用，大部分患者携带DRBl＊0406基因，多合并Graves病等自身免疫性疾病，以服用甲巯咪唑等药物为诱因，以血浆高胰岛素水平、高C肽水平、高滴度的胰岛素自身抗体（IAA）为主要特征。IAS具有自限性，停用诱发药物，辅以低碳水化合物、高蛋白、高纤维饮食，必要时给予小剂量糖皮质激素及免疫抑制剂，多数可缓解。

Insulin autoimroune syndrome （IAS）, which shows severe spontaneous hypoglycemia without a history of exogenous insulin administration,is contributed by both genetic factors and environmental factors. Most patients carry the gene DRB1 ＊ 0406, and often accompany with other immune disorders, such as Graves＇ disease. IAS is characterized by high total serum insulin, high C-peptide levels, and a high titer of in- sulin auto-antibodies （IAA）. Moreover, administration of methimazole is considered to be an incentive for it. Besides, IAS is self-limiting, and when stop using the triggered drugs, it can be eased by a low carbonhydrate, high protein, and high fiber diet. A small dose of glucocorticoid can also be applyed when necessary.