外源性胰岛素诱发的胰岛素自身免疫综合征一例诊治分析并文献复习  

A patient with insulin autoimmune syndrome induced by exogenous human insulin analogues:A case report and literature review

作　　者：朱凌云[1] 朱余蓉[1] 孙侃[1] 常向云[1] 党玉婷[1] 尹亮[1] 种琨瑛[1] 

机构地区：[1]新疆石河子大学医学院第一附属医院内分泌代谢科,832008

出　　处：《中国糖尿病杂志》2017年第8期743-747,共5页Chinese Journal of Diabetes

基　　金：兵团科技攻关成果转化计划项目(2015AD006)

摘　　要：回顾我院收治的1例T2DM患者使用诺和锐30后诱发的自身免疫性综合征(EIAS),分析其临床诊治过程,包括实验室检查、鉴别诊断、治疗及预后。患者停用胰岛素后,行5hOGTT,示血糖波动大,胰岛素和C-P浓度明显分离现象。胰岛素自身抗体(IAA)阴性。停用胰岛素后改用阿卡波糖,随诊10月,低血糖发作减少至停止,胰岛素及C-P水平明显下降,但是胰岛素水平仍然高于正常值,随诊10个月后再次外送查IAA阳性。EIAS为较罕见的内分泌疾病,其临床表现具有特异性。对于高胰岛素性低血糖的糖尿病患者,检测IAA有助于提高诊断率及早诊断与正确治疗,可避免误诊所造成的不必要手术及严重不良后果。即使IAA阴性,也不能完全排除EIAS,随访观察或通过不同方法检测亦可辅助诊断。Here, we reported a patient with type 2 diabetes （T2DM）, who got diagnosis of exogenous immunological hypoglycemia （EIAS） after treatment of insulin aspart 30 in our hospital. Clinical diagnosis and treatment of this patient, including laboratory examination, differential diagnosis, treatment and prognosis were evaluated retrospectively. After stopping insulin treatment, this patient underwent 5 h oral glucose tolerance test （OGTT）. The result showed a large fluctuation of blood glucose （BG）, and a dissociation between C-peptide （C-P） and insulin. Insulin autoantibody （IAA） was negative. Then the patient stopped insulin,switched to aearbose,and followed up for 10 months. During follow up, insulin and C-P were significantly decreased, although insulin still above normal range. Ten months later, IAA was re-tested and the result became positive. EIAS is a rare endocrine disease, which has an unique clinical manifestation. In diabetic patients with high insulin hypoglycemia, IAA testing could improve the diagnostic rate of EIAS. Early diagnosis and correct treatment could avoid unnecessary surgery and serious consequences caused by misdiagnosis. Even if the IAA negative, EIAS cannot be completely ruled out. Long term follow-up or using different testing method may facilitate the diagnosis of EIAS.

关 键 词：低血糖 自身免疫性 外源性人胰岛素 胰岛素自身抗体 

分 类 号：R587.1[医药卫生—内分泌]