胰岛素瘤61例临床分析  

Analysis of Clinical Characteristics of 61 Cases of Insulinoma

作　　者：方晓玲 蒋映雪 姜烁 俞国盛 尤丽丽 陈映娜 劳国娟[1] FANG Xiao-ling;JIANG Ying-xue;JIANG Shuo;YU Guo-sheng;YOU Li-li;CHEN Ying-na;LAO Guo-juan(Department of Endocrinology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou,510120;Linzhi People's Hospital,Xizang)

机构地区：[1]中山大学孙逸仙纪念医院内分泌科,510120 [2]西藏自治区林芝市人民医院全科医学科

出　　处：《岭南急诊医学杂志》2024年第5期500-502,共3页Lingnan Journal of Emergency Medicine

基　　金：广东省代谢性疾病(糖尿病)临床医学研究中心(2020B1111170009);西藏自治区自然科学基金组团式援藏医学项目(XZ2024ZR-ZY097(Z))。

摘　　要：目的:总结61例胰岛素瘤患者的临床特征,探讨定性及定位诊断方法。方法:对1992年至2019年中山大学孙逸仙纪念医院经病理确诊的61例胰岛素瘤患者的临床资料进行回顾性分析。结果:胰岛素瘤患者误诊率高达34.4%;70.5%患者出现典型Whipple三联征;当静脉血糖<3 mmol/L时,C肽≥200 pmol/L、胰岛素≥3.0 mU/L、胰岛素释放指数(IRI)≥0.3及修正IRI≥50的患者分别为100%、97.1%、91.2%和94.1%;在术前定位检查中,腹部彩超、CT、MRI、超声内镜的阳性率分别是46.3%、82.4%、86.8%和96.3%。结论:胰岛素瘤临床表现复杂多样,容易漏诊和误诊;当血糖<3 mmol/L,首选C肽≥200 pmol/L和胰岛素≥3.0 mU/L作为胰岛素瘤定性诊断标准。MRI可作为临床上无创定位检查的首选方法,超声内镜可进一步提高胰岛素瘤检出率。Objective:To summarize the clinical characteristics and experience in the qualitative and localization diagnosis of insulinoma.Methods:A retrospective analysis was conducted on the clinical materials of 61 insulinoma patients confirmed by pathology from 1992 to 2019 at Sun Yat-sen Memorial Hospital.Results:34.4%of the patients were misdiagnosed,with 70.5%of patients exhibiting the typical Whipple′s triad.when blood glucose<3 mmol/L,C-peptide≥200 pmol/L,insulin≥3 mU/L,Insulin release index(IRI)≥0.3 and amended IRI≥50 occurred in 100%,97.1%,91.2%and 94.1%,respectively.The positive rates of examinations for localization before operation were transabdominal ultrasound 46.3%,CT 82.4%,MRI 86.8%and endoscopic ultrasonography 96.3%.Conclusions:The clinical presentation of insulinoma is complex and diverse,leading to frequent misdiagnosis and missed diagnosis.When blood glucose<3 mmol/L,C-peptide≥200 pmol/L and insulin≥3.0 mU/L should be prioritized as qualitative diagnostic criteria for in-sulinoma.MRI can be considered the primary choice for non-invasive localization examinations,and endoscopic ultrasound can further improve the detection rate of insulinoma.

关 键 词：胰岛素瘤 临床特征 定性诊断 定位诊断 

分 类 号：R736.7[医药卫生—肿瘤]