101例药物致胰岛素自身免疫综合征的文献分析

Literature analysis of 101 cases of drug-induced insulin autoimmune syndrome

目的:总结国内外引发胰岛素自身免疫综合征(insulin autoimmune syndrome,IAS)的药物类型及治疗方法,提高临床对IAS的重视。方法:以“胰岛素自身免疫综合征”和“insulin autoimmune syndrome”为主题词,分别在中国期刊全文数据库(中国知网)、万方数据-数字化期刊群、维普科技期刊数据库和PubMed数据库检索近10年来药物所致IAS病例,进行回顾性分析,汇总诱发IAS的药物,并对其临床表现、胰岛素水平、C肽水平及药物治疗情况进行总结。结果:共收集101例IAS患者,其中51例使用甲巯咪唑,21例使用外源性胰岛素;IAS发作时均有明显低血糖症状,胰岛素自身抗体均为阳性,血糖水平平均值为(2.43±0.56)mmol/L,胰岛素水平>300 mU/L的有67例(占66.33%),C肽水平为1.00~37.94 ng/ml。56例患者使用糖皮质激素类药物治疗,26例停用诱发药物,部分严重者需联合免疫抑制剂利妥昔单抗。结论:IAS能引起严重自发性低血糖,临床上较为罕见。药物导致的IAS中,多数为含巯基药物诱发,糖皮质激素治疗效果显著,预后良好。

Objective:To summarize the type of drugs that cause insulin autoimmune syndrome(IAS)and treatment methods of IAS both at home and abroad,so as to arouse the attention of medical personnels to such problems clinically.Methods:Data retrieval from the Chinese Journal Full-text Database in China National Knowledge Infrastructure(CNKI),Wanfang Data-digitalization Journals,VIP China Science and Technology Journal Database and PubMed in recent 10 years was performed with“insulin autoimmune syndrome”as the subject keyword.Totally,101 cases of drug-induced IAS were collected and a retrospective analysis was made,and the drugs that induced IAS were also collected.Then,such data as clinical manifestations,insulin levels,C peptide levels and drug treatment status were statistically analyzed in the study.Results:Collected for study were a total of 101 IAS cases,of which 51 cases were treated with methimazole and 21 cases were treated with exogenous insulin.Obvious symptoms of hypoglycemia were shown when IAS attacked,with the insulin autoantibody being positive,and average blood glucose level being(2.43±0.56)mmol/L.There were 67 cases,whose insulin level was higher than 300 mU/L accounting for 66.33%,with C peptide level ranging from 1.00 to 37.94 ng/ml.Fifty-six cases were treated with glucocorticoids,and 26 cases abandoned those drugs that induced IAS.Some serious cases required treatment with a combination of immunosuppressive agent rituximab.Conclusion:IAS could cause severe spontaneous hypoglycemia,which was quite rare in clinical practice.In those drug-induced IAS,most cases were induced by drugs containing sulfhydryl.Glucocorticoids could achieve significant effects with good prognosis.