60例胰岛素瘤临床特点分析

The clinical characteristics of 60 patients with insulinoma

目的探讨胰岛素瘤的临床特点及诊断方法。方法回顾性分析2013年1月至2018年9月郑州大学第一附属医院收治的60例病理确诊为胰岛素瘤患者的临床资料。结果26.67%(16/60)的患者曾被误诊;均有Whipple三联征表现,血糖<3 mmol/L时,100%(60/60)患者血清胰岛素≥3 mU/L且血清C-肽≥0.6 ng/mL;75%(45/60)的患者胰岛素释放指数(IRI)≥0.3,91.67%(55/60)的患者修正后IRI≥50。术前经腹超声、CT、灌注CT、MRI及内镜超声(EUS)检查的阳性率分别为26.67%(16/60)、87.50%(21/24)、94.29%(33/35)、75.00%(6/8)、100%(3/3)。所有患者均接受手术治疗,最终术后病理确诊为胰岛素瘤。结论胰岛素瘤患者容易被误诊。对有Whipple三联征表现的可疑患者,胰岛素瘤定性诊断的首选标准为血清胰岛素≥3 mU/L和C-肽≥0.6 ng/mL,定位诊断则首选灌注CT,EUS可作为对常规定位检查的补充,病理是最终确诊的金标准。

Objective To discuss the clinical characteristics and diagnosis of insulinoma.Methods The clinical materials of 60 patients who were confirmed as insulinoma by pathology in the First Affiliated Hospital of Zhengzhou University from January 2013 to September 2018 were retrospectively analyzed.Results 26.67%(16/60)of the patients were misdiagnosed.All of the patients had Whipple’s triad,when blood glucose levels were below 3 mmol/L,insulin≥3 mU/L and C-peptide≥0.6 ng/mL occurred in 100%(60/60).Insulin release index(IRI)≥0.3 occurred in 75%(45/60),and amended IRI≥50 occurred in 91.67%(55/60).The positive rates of preoperative localization examination transabdominal ultrasound,CT,perfusion CT,MRI and endoscopic ultrasonography(EUS)were 26.67%(16/60),87.50%(21/24),94.29%(33/35),75.00%(6/8),100.00%(3/3),respectively.All of the patients underwent surgical treatment,and they were confirmed as insulinoma by pathology at end.Conclusion Misdiagnosis of insulinoma is common.For suspected patients with Whipple’s triad,the primary choice for qualitative diagnosis of insulinoma is insulin≥3 mU/L and C-peptide≥0.6 ng/mL,and the primary choice for localization diagnosis of insulinoma is perfusion CT.EUS can be complementary to the routine imaging examination.Pathology is the golden standard for the final diagnosis of insulinoma.