奥美拉唑致胰岛素自身免疫综合征  

Insulin autoimmune syndrome caused by omeprazole

作　　者：唐彦[1] 张娟[2] 张树杰[3] 姜艳[4] 周翔[4] Tang Yan;Zhang Juan;Zhang Shujie;Jiang Yan;Zhou Xiang(Department of Pharmacy,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Pharmacy,Yantai Yuhuangding Hospital,Shandong Province,Yantai 264000,China;Department of Endocrinology,Handan Central Hospital,Hebei Province,Handan 057150,China;Department of Endocrinology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院/北京协和医院药剂科,北京100730 [2]烟台毓璜顶医院药学部,烟台264000 [3]邯郸市中心医院内分泌科,邯郸057150 [4]中国医学科学院北京协和医学院/北京协和医院内分泌科,北京100730

出　　处：《药物不良反应杂志》2024年第8期506-509,共4页Adverse Drug Reactions Journal

基　　金：中央高水平医院临床科研项目(2022-PUMCH-A-156,2022-PUMCH-B-059)。

摘　　要：1例74岁女性多次发作性头晕、心悸、大汗,其中2次发作时静脉血糖分别为2.4 mmol/L、2.5 mmol/L时,C肽分别为6.79μg/L、6.24μg/l,胰岛素>1500 mU/L,胰岛素原2896 ng/L、2989 ng/L;尿酮体(-),胰岛素自身抗体(IAA)>400 RU/ml,符合胰岛素介导的低血糖症。患者有间断服用奥美拉唑用药史,无糖尿病病史,否认外源性胰岛素、磺脲类及含巯基药物用药史。根据体检和相关检查,结合患者人类白细胞抗原(HLA)分型为HLA‑DRB104∶03和用药史,考虑患者为奥美拉唑致胰岛素自身免疫综合征可能性大。停用奥美拉唑,调整饮食结构并加用阿卡波糖治疗3个月后,患者IAA水平降至36 RU/ml,空腹胰岛素降至131.7 mU/L;9个月后,患者IAA转阴,空腹胰岛素降至23.3 mU/L,未再发生低血糖。A 74‑year‑old female had multiple episodes of dizziness,palpitations,and sweating,among the 2 episodes,her venous blood glucose levels were 2.4 mmol/L and 2.5 mmol/L,C‑peptide levels were 6.79 mg/L and 6.24μg/L,insulin>1500 mU/L,and synchronous proinsulin levels were 2896 ng/L and 2989 ng/L.The patient′s urinary ketone bodies was negative,and insulin autoantibodies(IAA)was>400 RU/ml.These indicators were accorded with insulin mediated hypoglycemia.The patient had a history of taking omeprazole intermittently,had no history of diabetes,and refuted the history of using exogenous insulin,sulfonylureas and sulfhydryl drugs.Based on physical examination and relevant examinations,combined with the patient′s human leukocyte antigen(HLA)classification(HLA‑DRB104∶03)and medication history,it was considered that the patient was more likely to have omeprazole‑induced insulin autoimmune syndrome.Omeprazole was stopped.After adjusting the dietary structure and adding acarbose treatment for 3 months,the patient′s IAA level decreased to 36 RU/ml,and the fasting insulin decreased to 131.7 mU/L;after 9 months,the patient′s IAA turned negative and their fasting insulin decreased to 23.3 mU/L,with no further episodes of hypoglycemia.

关 键 词：低血糖症 质子泵抑制剂 奥美拉唑 胰岛素自身免疫综合征 易感基因 

分 类 号：R969[医药卫生—药理学]