胰岛素制剂注射致脂肪萎缩临床特点分析

Insulin-induced lipoatrophy： an analysis of clinical features

目的探讨胰岛素制剂注射致脂肪萎缩的临床表现、发病机制及治疗方案。方法对北京协和医院1例胰岛素制剂注射致外源性胰岛素抗体综合征（EIAS）及获得性脂肪萎缩的病例进行临床资料收集和分析，并总结2010年1月至2018年1月北京协和医院收治的胰岛素制剂注射致脂肪萎缩患者的临床特点。结果胰岛素制剂注射致脂肪萎缩患者共11例，其中注射部位脂肪萎缩11例，同时出现非注射部位脂肪萎缩2例。制剂种类包括重组人胰岛素制剂及胰岛素类似物制剂，脂肪萎缩在注射后2个月至3年出现。8例患者胰岛素自身抗体（IAA）滴度升高，其中6例患者同时有血糖波动大，夜间低血糖及血清胰岛素水平升高的临床特点，符合EIAS。结论胰岛素制剂注射可引起注射局部和非注射部位的脂肪萎缩，并可有EIAS表现。IAA与EIAS及脂肪萎缩关系密切，临床上二者可同时发生，均与胰岛素触发自身免疫反应有关。当出现无法解释的血糖波动及脂肪萎缩时，应注意监测血清胰岛素水平及IAA，警惕EIAS可能。

ObjectiveTo explore the clinical manifestations, pathogenesis and treatment of insulin-induced lipoatrophy.MethodsData of a case of exogenous insulin antibody syndrome （EIAS） and acquired lipoatrophy caused by insulin injection were collected and analyzed. From January 2010 to January 2018, clinical data of patients diagnosed with insulin-induced lipoatrophy in Peking Union Medical College Hospital were summarized.ResultsA total of 11 cases were diagnosed as insulin-induced lipoatrophy with 11 cases of lipoatrophy at the injection site, while 2 cases with present of lipoatrophy at the non-injection site. Both recombinant human insulin preparations and the insulin analog preparations were involved in lipoatrophy. It mostly occurred in 2 weeks to 3 years after the initiation of insulin injection. High titers of insulin autoantibodies （IAA） were found in 8 patients, of which 6 patients manifested with blood glucose fluctuation, hypoglycemia at night and elevated serum insulin level, which could be diagnosed as EIAS.ConclusionBoth localized lipoatrophy and distant site lipoatrophy could be induced by insulin injection. High titers of IAA could lead to both EIAS and lipoatrophy which may occur at the same time. The mechanism might be attributed to autoimmune reaction triggered by insulin injection. When encountered with unexplained blood glucose fluctuations with concomitant lipoatrophy, serum insulin levels and IAA tests are strongly recommended to confirm EIAS.