硫辛酸致胰岛素自身免疫综合征国内外文献分析  

Insulin autoimmune syndrome induced by lipoic acid:Analysis of literature in China and abroad

作　　者：梁乐 鱼丽萍 张迪[3] 姚杨[4] 朱琳 LIANG Le;YU Li-Ping;ZHANG Di;YAO Yang;ZHU Lin(Department of Pharmacy,the First People's Hospital of Xianyang,Xianyang 712000,China;Department of Neurology,the First People's Hospital of Xianyang,Xianyang 712000,China;Department of Pharmacy,First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;The First Affiliated Hospital of Xi’an Medical University,Xi’an 710061,China)

机构地区：[1]咸阳市第一人民医院药学部,陕西咸阳712000 [2]咸阳市第一人民医院神经内科,陕西咸阳712000 [3]西安交通大学第一附属医院药学部,陕西西安710061 [4]西安医学院第一附属医院,陕西西安710061

出　　处：《现代药物与临床》2022年第4期882-887,共6页Drugs & Clinic

基　　金：陕西省重点研发计划一般项目(2021SF-226);陕西省重点研发计划一般项目(2020SF-062)。

摘　　要：目的探讨硫辛酸致胰岛素自身免疫综合征(IAS)的临床特点,为临床安全用药提供依据。方法检索国内外数据库收集硫辛酸致IAS的病例报告类文献,提取相关数据(性别、国籍、年龄、原发疾病、联用药物、IAS发生时间及相关实验室检查、主要症状、临床干预措施及转归)进行描述性统计分析,同时对相关厂家药品说明书进行查阅分析。结果纳入分析的21例患者,男性4例,女性17例;年龄32~77岁,平均57.71岁;11例患者合并其他药品,其中5例患者合并使用胰岛素或胰岛素促泌剂格列齐特,患者使用二甲双胍或阿卡波糖为5例;4例患者在用药过程中发生IAS,12例患者为停用硫辛酸后发生IAS;患者低血糖发作时血糖平均为2.46 mmol/L;21例患者血清胰岛素均高于正常水平且胰岛素自身抗体(IAA)均为阳性。对14例患者进行基因型检测,中国、日本和韩国患者基因型均为HLA-DRB1*0406,非东亚患者基因型分别为HLA-DRB1*0403或HLA-DRB1*0415。21例患者均停用硫辛酸,其中6例患者停药后未干预患者好转,9例患者同时给予糖皮质激素治疗,1例患者给予二氮嗪,1例患者给予糖皮质激素后仍未改善最终给予血浆置换治疗,21例患者均好转。结论糖尿病患者使用硫辛酸时发生低血糖症状应警惕硫辛酸所致IAS,临床用药过程中应加强用药监护,同时相关企业应完善药品说明书,确保患者安全用药。Objective To explor the clinical characteristics of insulin autoimmune syndrome induced by lipoic acid.Methods Cases of insulin autoimmune syndrome caused by lipoic acid were collected and analyzed statistically in China and abroad,extracted literatures were analyzed statistically in respects of patient’s gender,nationality,age,primary disease,combined drugs,insulin autoimmune syndrome occurrence time,insulin autoimmune syndrome related laboratory examination,main symptoms,clinical intervention measures and outcome.At the same time,the drug instructions of four domestic manufacturers were consulted and analyzed.Results The 21 patients included in the analysis were 4 males and 17 females.The age ranged from 32 to 77 years,with an average of 57.71 years.11 patients were combined with other drugs,of which 5 patients were combined with insulin or insulin secretagogue such as gliclazide,5 patients were treated with metformin or acarbose.IAS occurred in 4 patients and 12 patients after stopping lipoic acid,the average blood glucose was 2.46 mmol/L at the onset of hypoglycemia.The serum insulin level of 21 patients was higher than normal,insulin autoantibody(IAA)was positive.Genotypes were detected in 14 patients,the genotypes of Chinese,Japanese and Korean patients were HLA-DRB1*0406,and those of non East Asian patients were HLA-DRB1*0403 or HLADRB1*0415.Lipoic acid was stopped in 21 patients,of which 6 patients did not interfere with the improvement after drug withdrawal,9 patients were treated with glucocorticoid,1 patient was treated with diazoxide,1 patient was treated with glucocorticoid and did not improve,finally plasma exchange treatment was given,all patients were improved.Conclusion When lipoic acid is used to produce hypoglycemic symptoms,we should be alert to insulin autoimmune syndrome,strengthen medication monitoring in the process of clinical medication,and relevant enterprises should improve the drug instructions and ensure patients safety.

关 键 词：硫辛酸 低血糖 胰岛素自身免疫综合征 病例分析 

分 类 号：R977[医药卫生—药品]