胰岛素自身免疫综合征3例报告及文献复习

Three cases of insulin autoimmune syndrome and literature review

目的总结分析国内胰岛素自身免疫综合征(insulin autoimmune syndrome,IAS)病人的临床资料,以期提高临床对IAS的认识。方法对2013年6月至2018年12月于西安高新医院确诊为IAS的3例病人和2009年6月至2019年6月于各大数据库中检索到关于IAS的87例国内个案报道进行回顾性分析,总结其病史、临床表现、生化特点、治疗及预后等临床资料。结果通过对90例IAS病例进行回顾性统计分析,数据显示IAS男女比例1∶2,女性IAS病人比例高于男性病人(P<0.05),且发病年龄主要集中在>39~59岁;甲巯咪唑所致IAS所占比例52.22%,高于其他诱发药物(P<0.001);低血糖发作时VPG(2.05±0.67)mmol/L,低血糖症状控制不佳时激素治疗有效,经治疗后随访3月内低血糖未再发作者66例,其中29例IAS病人予以激素治疗,经激素治疗和非激素治疗胰岛素自身抗体(IAA)转阴的时间差异无统计学意义(P>0.05)。结论IAS病人女性较多见,好发年龄段为>39~59岁,甲巯咪唑是诱发IAS的常见药物,治疗上必要时可予以小剂量激素。

Objective To summarize and analyze the clinical data of patients with insulin autoimmune syndrome(IAS),so as to improve the clinician's understanding of IAS.Methods A retrospective analysis was made of 3 confirmed cases in Endocrinology Department of Xi'an Gaoxin Hospital from June 2013 to December 2018,and 87 cases reported in domestic literatureretrieval retrieved from respective databases from June 2009 to June 2019.Their medical history,clinical manifestations,biochemical parameters,treatment and prognosis were summarized and analyzed.Results Of the 90 IAS cases,the ratio of male to female patients was 1∶2,which suggested that the incidence of female IAS patients was higher than male patients(P<0.05).The patients'age of onset was mainly in the group of>39-59 years old.The proportion of IAS induced by methimazole was 52.22%,higher than that induced by other drugs(P<0.001).The mean value of venous plasma glucose(VPG)during hypoglycemia onset was(2.05±0.67)mmol/L.Glucocorticoid therapy was effective,when hypoglycemia symptom was poorly controlled.During the 3-month follow-up after treatment,the hypoglycemic episodes of 66 cases had disappeared.And among them,29 IAS patients received glucocorticoid therapy.But there was no statistical difference in the time of IAA turning negative between glucocorticoid therapy and non-glucocorticoid therapy(P>0.05).Conclusion IAS is inclined to occur in female,and the age group of onset is mainly in the range of>39-59 years old.Methiazole is the most common drug that induces IAS.Therapeutically,a low dose of glucocorticoids can be used when necessary to achieve satisfactory treatment effect.