聚乙二醇沉淀法和凝胶层析分离法在糖尿病患者使用外源性胰岛素所致低血糖鉴别诊断中的应用价值初探

Preliminary investigation on application value of polyethylene glycol precipitation and gel chromatography in differential diagnosis of hypoglycemia induced by exogenous insulin in patients with diabetes mellitus

本文初步探讨聚乙二醇沉淀法和凝胶层析分离法在糖尿病患者使用外源性胰岛素所致低血糖鉴别诊断中的价值。通过对2例在注射胰岛素过程中反复发生不明原因低血糖的糖尿病患者，以聚乙二醇沉淀法和凝胶层析分离法对其血清进行鉴定分析，明确是否存在胰岛素抗体。结果发现，病例1患者血清在PEG沉淀前后测定胰岛素水平无明显差异，凝胶层析分离法出现正常胰岛素峰，诊断为过量外源性胰岛素所致低血糖。病例2患者血清在PEG沉淀后胰岛素水平显著低于处理前，凝胶层析分离法出现大分子胰岛素峰，考虑为外源性胰岛素抗体综合征。结论表明对于注射胰岛素过程中反复发生不明原因低血糖的糖尿病患者，可应用聚乙二醇沉淀法和凝胶层析分离法确定患者体内有无胰岛素抗体存在。

To preliminarily investigate application value of polyethylene glycol precipitation （PEG） and gel chromatography in the differential diagnosis of hypoglycemia induced by exogenous insulin in patients with diabetes mellitus. PEG precipitation and gel chromatography were used to detect the serum in two diabetic patients with recurrent unexplained hypoglycemia during injection of insulin. The results showed that case 1 was diagnosed as hypoglycemia induced by excess exogenous insulin, because there was no significant difference in the level of serum insulin before and after PEG precipitation, gel chromatography showed normal insulin peak. Case 2 was diagnosed as exogenous insulin antibody syndrome, because the level of serum insulin after PEG precipitation was significantly lower than before PEG precipitation, gel chromatography showed high molecular weight of insulin peak. The study shows PEG precipitation and gel chromatography can be used to determine whether there is insulin antibody for diabetic patients with unexplained hypoglycemia during injection of insulin.