糖尿病患者应用胰岛素后出现胰岛素自身免疫综合征2例

Two cases of insulin autoimmune syndrome induced by exogenous insulin in diabetic patients

目的提高临床医师对外源性胰岛素诱发胰岛素自身免疫综合征(insulin autoimmune syndrome,IAS)的认识。方法回顾性分析2例使用外源性胰岛素后诱发IAS患者的临床诊治过程及特点。结果 2例患者均有低血糖表现,低血糖发生在夜间;行馒头餐试验示有胰岛素和C肽分离现象,胰岛素自身抗体(insulin autoimmune anti-body,IAA)均为高滴度阳性;改用口服降糖药物后低血糖发作逐渐缓解。结论因被胰岛素自身的作用掩盖,糖尿病患者应用外源性胰岛素后诱发的IAS容易被漏诊,高滴度IAA以及胰岛素和C肽分离现象具有诊断价值。

Objective To improve the recognition of clinicians on insulin autoimmune syndrome（IAS） induced by exogenous insulin. Method Two cases of IAS induced by exogenous insulin were retrospectively analyzed. Result The two patients had hypoglycemia occurred during the night. They had dissociation between C-peptide and insulin, accompanied by high titer of insulin autoantibody（IAA）.After removing of possible offending medication and using of oral hypoglycemic agents, hypoglycemic episodes were ameliorated. Conclusion Due to the role of insulin to cover up, diabetes patients after the application of exogenous insulin induced IAS are easily misdiagnosed, high titer IAA and insulin and C peptide separation phenomenon have confirmed diagnostic value.