甲巯咪唑致中国人群胰岛素自身免疫综合征的临床特点分析

Clinical characteristics of insulin autoimmune syndrome caused by methimazole in Chinese population

目的:探讨中国人群甲巯咪唑致胰岛素自身免疫综合征(IAS)的临床特点。方法:收集1985年1月1日至2019年6月30日国内外期刊公开发表的中国人群甲巯咪唑致IAS病例文献,进行回顾性分析。结果:共统计95例甲巯咪唑致IAS患者,男性发病年龄早于女性,性别比为1∶2.31;服用甲巯咪唑30 mg/d后在1月至3月内发生IAS最多,主要在夜间及凌晨以神经性低血糖为首发症状,血糖一般在2 mmol/L以下,胰岛素浓度常≥100 mU/L,胰岛素自身抗体(IAA)阳性。胰腺影像学无明显异常;停用甲巯咪唑,给与对症及激素治疗后,症状逐渐缓解,激素治疗与非激素治疗低血糖消失时间无明显区别。结论:甲巯咪唑致IAS是一种临床上少见的自身免疫性疾病,服药期间如出现低血糖或高血糖现象,应及时就诊和处理,正确治疗后,一般预后良好。

AIM:To explore the clinical features of insulin autoimmune syndrome(IAS)induced by methimazole in Chinese population.METHODS:The literature on IAS cases caused by methimazole in the Chinese population published before and after June 30,2019 was collected for retrospective analysis.RESULTS:The age of onset of men was earlier than that of women,and the sex ratio was 1∶2.31 in 95 patients.After taking methimazole 30 mg/d,IAS occurred most from one month to three months,characterized by neuropathic hypoglycemia as the first symptoms at night and early in the morning,blood sugar below 2 mmol/L,insulin concentration≥100 mU/L,IAA positive and no obvious abnormalities in pancreas imaging.The symptoms gradually relieved after symptomatic treatment and stopped taking methimazole.There was no significant difference in the time of hypoglycemia disappearance between the 54 patients who received hormone therapy and non-hormone therapy.CONCLUSION:Methimazole-induced IAS is a clinically rare autoimmune disease.It should be treated promptly occuring hypoglycemia or hyperglycemia during medication.The prognosis of IAS is generally good after proper treatment.