胰岛素自身免疫综合征1例的诊断和治疗  

Diagnosis and treatment of insulin autoimmune syndrome:a case report and literature review

作　　者：艾智华[1] 胡朝恩 钟大鹏[1] 

机构地区：[1]成都军区总医院内分泌科,成都610083

出　　处：《第三军医大学学报》2014年第7期713-715,共3页Journal of Third Military Medical University

摘　　要：目的探讨胰岛素自身免疫综合征(insulin autoimmune syndrome,IAS)的发病机制、临床表现、诊断方法和治疗措施。方法我院收治1例中年男性患者,反复发生低血糖性昏迷,诊断为IAS,结合相关文献复习,对该病的临床特点进行分析。结果患者因"Graves病"服用甲巯咪唑治疗1个月后,出现"Whipple"三联征,75 g葡萄糖耐量试验发现血糖水平升高,而空腹及餐后免疫活性胰岛素显著增高,餐后胰岛素大于1 000 mU/L。患者胰岛素自身抗体(IAA)阳性。停用甲巯咪唑后,给予泼尼松30 mg/d治疗,并逐渐减量,患者低血糖症状缓解,1年后复查血糖和胰岛素水平恢复正常,IAA阴性。结论胰岛素自身免疫综合征是一种导致低血糖反复发作的少见病因,可由甲巯咪唑引起,胰岛素水平和胰岛素自身抗体的测定有助于诊断。Objective To investigate the etiology, manifestations, diagnosis and treatment of insulin autoimmune syndrome （IAS）. Methods One adult male patient, suffered from frequent hypoglycemia was admitted in our department on March 4, 2012. He was finally diagnosed as IAS. The clinical features of the case was analyzed in combination with literature review. Results After taking methimazole for a month for the treatment of Graves＇ disease, the patients manifested clinical symptoms of Whipple＇ s triad. The results of 75 g OGTF test showed that serum glucose was increased, both fasting and postprandial serum insulin were increased, and the postprandial serum insulin level was higher than 1 000 mU/L. The result of Insulin autoanti body （IAA） was positive. After methimazole was stopped, prednisone 30 mg/d was used, with the dosage gradually reduced. The symptoms of hypoglycemia diminished, with the recovery of plasma glucose and insulin levels and negative IAA. Conclusion IAS is a rare disease which may result in repeated episode of hypogly cemia. It may be caused by methimazole. To assay serum insulin and insulin autoantibody are greatly helpful to distinguish IAS.

关 键 词：胰岛素自身免疫综合征 甲巯咪唑 胰岛素自身抗体 高胰岛素血症 低血糖症 

分 类 号：R587[医药卫生—内分泌] R593.2[医药卫生—内科学]