药物致胰岛素自身免疫综合征临床特点及药学监护

Clinical characteristics and pharmaceutical care of drug-induced insulin autoimmune syndrome

目的:通过总结药物致胰岛素自身免疫综合征(IAS)的临床特点,为临床药师在临床实践中处置不良反应以及药学监护提供参考。方法:回顾性收集2009年1月–2020年6月我院内分泌科收治的药物致IAS患者的病历资料,对患者性别、发病年龄、病程、低血糖发作时间、实验室检查等信息进行汇总,分析药物致IAS的怀疑药物、不良反应关联性评价结果、治疗措施等,并结合文献复习归纳总结药物致IAS的种类,作用机制以及处理措施。结果:共14例药物致IAS患者,不良反应关联性评价“很可能”10例,“可能”4例,致IAS药品中含巯基的有11例(甲巯咪唑4例,胰岛素4例,α-硫辛酸1例,还原型谷胱甘肽1例;卡托普利1例);含有巯基代谢产物的(氯吡格雷)1例;保健品1例;中药1例。结论:药物致IAS以含巯基的药物多见,但近年来非巯基药物以及“隐形”含巯基药物引起的IAS逐渐增多,临床药师应协助医师尽早发现药物致病因素,确保患者用药安全。

Objective:To summarize the clinical characteristics of drug-induced insulin autoimmune syndrome(IAS),and provide references for clinical pharmacists in the treatment of adverse drug reactions in clinical practice and pharmaceutical care.Methods:Data of the patients with drug-induced IAS who were admitted to the department of endocrinology from January 2009 to June 2020 including the gender,age of onset,duration of disease,time of hypoglycemia,laboratory examinations,etc were retrospectively collected and analyzed in terms of the suspected drugs,the results of relevance evaluation,and the treatment of drug-induced IAS,thus to summarize the kind of drugs causing drug-induced IAS,the mechanism of action and the treatment regimen combined with literature review.Results:A total of 14 patients with drug-induced IAS were enrolled in this study.There were 10 cases of"probable"and 4 cases of"possible"after relevance evaluation.There were 11 cases caused by sulfhydryl drugs including 4 cases of methimazole,4 cases of insulin,one case ofα-lipoic acid,one case of glutathione,and one case of captopril,one case caused by clopidogrel containing sulfhydryl metabolite,one case caused by health products,and one case caused by traditional Chinese medicine.Conclusion:Drug-induced IAS was commonly caused by sulfhydryl-containing drugs.However,drug-induced IAS induced by non-sulfhydryl drugs and"invisible"sulfhydryl-containing drugs gradually increased in recent years.Clinical pharmacists should assist doctors to fi nd the pathogenic factors of drugs as soon as possible to ensure the safety of patients.