胰岛素自身免疫综合征临床特点分析及文献复习

Analysis of clinical characteristics of insulin autoimmune syndrome and related literature review

目的回顾性分析总结7例胰岛素自身免疫综合征(insulin autoimmune syndrome,IAS)患者的临床特点并文献复习。方法通过病例系统收集2012年12月至2022年3月7例IAS患者的临床资料,各项化验指标均由首都医科大学附属北京安贞医院检验科完成。结果7例患者中男性4例,女性3例;多在60~70岁发病;2例合并自身免疫疾病。其中6例为外源性IAS。7例胰岛素水平均异常升高、C肽水平均无下降、胰岛素自身抗体(insulin auto-antibody,IAA)均为阳性;7例均表现有低血糖症状,1例最低血糖4.2 mmol/L;5例患者胰岛素/C肽摩尔比>1。停用可疑药物、膳食调整联合α糖苷酶抑制剂、二甲双胍治疗有效。结论不能因未监测到低血糖而否定IAS可能,对于应用胰岛素治疗的糖尿病患者当血糖控制欠佳时应警惕外源性IAS可能,遗传学鉴定或对本病的诊断及预防有意义。

Objective A retrospective study was conducted to analysis the clinical characteristics of 7insulin autoimmune syndrome(IAS)patients.Methods Clinical data were collected by searching the computerized database.Results The male-female ratio of these seven patients was 4:3;age of the four patients was between 60-70 years old;two patients with the history of Hashimoto's disease.Of the seven cases,six wereexogenous IAS.The level of insulin was excessively high,the level of C-peptide was not low,and insulin auto-antibodies(IAA)were positive of all the seven patients.The lowest blood glucose of one patient was 4.2 mmol/L.The insulin to C-peptide molar ratios were>1 in five patients.Symptoms were relieved after discontinuing use of the suspicious drugs,small frequent meals,taking acarbose and metformin.Conclusions IAS should not be easily excluded in patients without hypoglycemia record.For diabetes patients receiving insulin therapy,exogenous IAS might be mistaken as hypoglycemia induced by insulin overdose.The identification of the genotype might be meaningful in the diagnosing and prevention of IAS.