胰岛素自身免疫综合征临床特征及随访资料分析并文献复习  

Insulin autoimmune syndrome ： An analysis of clinical features, following up data, and review of literature

作　　者：陈敏[1,2] 窦京涛[1] 王先令[1] 谷伟军[1] 杜锦[1] 郭清华[1] 杨国庆[1] 巴建明[1] 吕朝晖[1] 母义明[1] 陆菊明[1] 

机构地区：[1]解放军总医院内分泌科,北京100853 [2]首都医科大学附属复兴医院内分泌科

出　　处：《中华内分泌代谢杂志》2012年第10期813-816,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的分析胰岛素自身免疫综合征（IAS）的临床特征和预后，结合文献加深对IAS的认识。方法回顾性分析9例IAS患者的临床资料并进行随访。结果9例患者均有低血糖表现，低血糖可发生在空腹和餐后；大部分患者（8／9）合并自身免疫性疾病，其中6例为Graves病，并都在发病前用他巴唑治疗；实验室检查提示低血糖时血胰岛素水平明显升高（9／9），胰岛素自身抗体阳性（7／9）；影像学检查多呈阴性（8／9）；停用诱发药物和调整饮食后，部分患者（5／9）症状缓解，未见缓解者加用阿卡波糖（1／9）或强的松（3／9）后有效：完成随访7例，随访期间4例无复发、3例症状减轻。结论IAS的诊断要点为低血糖、高胰岛素血症和胰岛素自身抗体阳性。IAS常合并自身免疫性疾病，他巴唑是其常见的诱发药物，停用诱发药物、调整饮食及强的松口服对大多数IAS有效。Objective To analyze the clinical characteristics and prognosis of patients with insulin autoimmune syndrome （IAS） and to get better understanding of IAS by literatures reviewing. Methods Nine cases of IAS who were diagnosed in the General Hospital of the People＇s Liberation Army from 2001 to 2011 were analyzed. Results All patients had hypoglycemic syndrome and episodes of hypoglycemia during both postprandial and fasting states. Most cases （ 8/9 ） were accompanied with autoimmune diseases, including 6 cases of Graves＇ disease treated with methimazole. The biochemical data showed extremely elevated serum insulin level （ 9/9 ） during hypoglycemic episode. For most patients, the tests of insulin autoantibodies were positive （ 7/9 ） while results of imaging examinations were negative （8/9）. After removal of possible offending medications and with diet treatment, hypoglycemic episodes were ameliorated in 5 of 9 cases. For severe patients, acarbose （ I/9 ） and prednisone （ 3/9 ） therapy were useful. During the period of follow-up, four cases experienced no episode of hypoglycemia and 3 cases with markedly reduced episodes. Conclusions IAS is characterized by hypoglycemic episodes, elevated blood insulin levels, and positive insulin autoantibodies. It is strongly related with autoimmune disease and is able to be induced by methimazole. Most patients undergo remission after diet treatment, drug withdrawal, and oral prednisone.

关 键 词：胰岛素自身免疫综合征 低血糖症 胰岛素自身抗体 

分 类 号：R593.2[医药卫生—内科学]