甲巯咪唑致胰岛素自身免疫综合征文献分析

Literature analysis of insulin autoimmune syndrome induced by methimazole

目的探讨甲巯咪唑致胰岛素自身免疫综合征(IAS)的发生规律及特点。方法检索PubMed、Web of Science、Embase、维普、中国知网和万方数据库(截至2021年1月),收集甲巯咪唑致IAS的病例报告类文献,加上咸阳市第一人民医院收治的1例病例,提取相关数据,分析甲巯咪唑致IAS的特点。结果纳入分析的患者64例,男性13例,女性51例;年龄15~76岁;其中95.31%的患者为Graves甲亢;51.28%的患者发生低血糖时间无规律,血糖最低可降至0.70 mmol/L;93.88%的患者胰岛素/C肽摩尔比>1;57.28%的患者发生低血糖时表现为神志不清或昏迷;9例患者发生IAS之前使用甲巯咪唑时出现皮疹的不良反应;98.36%的患者胰岛素自身抗体为阳性;大部分患者影像学检查未见明显异常。确诊为IAS的患者中,63例患者停用甲巯咪唑,23例患者同时给予糖皮质激素治疗,64例患者低血糖症状均好转。结论服用甲巯咪唑时发生低血糖应警惕IAS,停用药物,视病情给予相应治疗,预后良好。

Objective To explor the clinical characteristics of insulin autoimmune syndrome(IAS)induced by methimazole.Methods Case reports of IAS induced by methimazole were collected through searching PubMed,Web of Science,Embase,VIP,CNKI and Wangfang(as of January 2021).The clinical characteristics of IAS induced by methimazole were analyzed according to the above literature and the information from 1 related patient admitted to the First People′s Hospital of Xianyang.Results Totally 64 patients were included in the analysis,including 13 males and 51 females,aged 15~76 years.About 95.31%of the patients were Graves hyperthyroidism;the time of hypoglycemia occurrence was irregular in 51.28%of patients,and the lowest blood glucose could be reduced to 0.70 mmol/L;93.88%of the patients had insulin/C-peptide molar ratio>1;57.28%of the patients showed unconsciousness or coma when hypoglycemia occurred;nine patients had skin rash when using methimazole before IAS occurred;98.36%of the patients were positive for insulin autoantibody;no obvious abnormality was found in imaging examination of most patients.Of patients with the diagnosis of IAS,63 patients stopped methimazole,23 patients were treated with glucocorticoid,and the symptoms of hypoglycemia were improved in 64 patients.Conclusion When hypoglycemia occurs during taking methimazole we should be alert to insulin autoimmune syndrome,stop taking drugs,and give corresponding treatment according to the condition.The prognosis is good.