多种胰岛素过敏的1型糖尿病患者脱敏一例及文献复习

Desensitization for one case of insulin allergic type 1 diabetes and review of literatures

目的报告对多种胰岛素过敏的1型糖尿病患者脱敏随访治疗情况，并复习国内外报道的相关资料，以提高对该病的诊治认识。方法对该患者用过小剂量序贯皮下注射胰岛素、胰岛素泵持续泵入胰岛素（诺和灵R、猪胰岛素）、地塞米松加入胰岛素泵诺和灵R中持续泵人等方法进行胰岛素脱敏治疗。监测指标为患者胰岛素注射部位的红斑、硬结直径及瘙痒程度以及胰岛素抗体水平。结果胰岛素泵治疗时，过敏反应较前明显减轻，尤其是方波输注模式时瘙痒明显减少。使用诺和灵R＋地塞米松胰岛素泵治疗时最少发生过敏反应，表现为注射部位无红斑，无硬结或偶有直径0．5cm的硬结，不伴瘙痒；胰岛素泵治疗结束3个月，胰岛素笔注射后，皮肤过敏反应逐渐减轻至消失，无红斑和瘙痒，大腿部位有时有小硬结，胰岛素抗体逐渐降低至正常，但出现右侧腹部局部脂肪萎缩。结论地塞米松与胰岛素混合加入胰岛素泵的方法胰岛素过敏反应最轻微，胰岛素泵方波输注模式有助减轻胰岛素过敏症状。

Objective To investigate the anti-allergic strategy by reporting the desensitization for one case of insulin allergic type 1 diabetes and reviewing relevant literatures. Methods Sequencing diluted insulin injection for desensitization, continuous subcutaneous insulin infusion （CSII） with Novolin R, or dexamethasone added into CSII were applied to desensitization. Observed the size of erythema and induration, the degree of itching around the site of insulin injection and measured the insulin antibody levels. Results The allergic reaction obviously alleviated during CSII, especially when the square mode of bolus was used. The slightest allergic reaction was seen during CSII with Dexamethasone, showing a small induration without erythema or itching. Three months after CSII, the erythema or itching around injection sites disappeared, except occasional small indurations at the thighs. The insulin antibody levels gradually declined to normal as well. However, a local lipoatrophy in the right abdomen turned up. Conclusions The allergic reaction is alleviated most when dexamethasone and insulin added into CSII. The square mode of bolus is helpful to alleviate the insulin allergic symptoms.