氯吡格雷诱发胰岛素自身免疫综合征1例  

Clopidogrel-induced Insulin Autoimmune Syndrome:a Case Report

作　　者：陈晓忠 陆慧琼 方伟 陈柳勤 符俊超 王子霞 CHEN Xiaozhong;LU Huiqiong;FANG Wei;CHEN Liuqin;FU Junchao;WANG Zixia(Department of Clinical Laboratory,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院)检验科,广东广州510080

出　　处：《标记免疫分析与临床》2025年第1期212-215,共4页Labeled Immunoassays and Clinical Medicine

基　　金：广东省医学科研基金(编号:A2024218);广东省人民医院国家自然科学基金培育项目(编号:KY0120220060)。

摘　　要：目的 探讨氯吡格雷诱发的胰岛素自身免疫综合征的临床特征以及实验室结果,提高对胰岛素自身免疫综合征的认识。方法 通过回顾性分析2020年8月到2023年4月在广东省人民医院就诊的1例氯吡格雷诱发的胰岛素自身免疫综合征患者先后两次发病的临床资料、实验室和影像学的检查结果以及诊疗过程。结果 男性患者,两次住院都因精神差,入睡困难,无明显诱因反复出现头晕、心慌、乏力、出冷汗和视物模糊等低血糖症状,实验室结果显示血糖降低、胰岛素异常升高、C肽升高、抗胰岛素自身抗体阳性,经过诊断与鉴别诊断最终诊断为胰岛素自身免疫综合征,第一次住院经过激素泼尼松片治疗后无低血糖症状出院,第二次住院明确诱发胰岛素自身免疫综合征的因素为氯吡格雷,停用氯吡格雷和使用激素泼尼松片治疗血糖正常。结论 氯吡格雷诱发的胰岛素自身免疫综合征罕见,其多表现为反复出现低血糖的症状,进食后缓解。停止服用诱发的药物以及结合激素治疗效果较好。Objective To investigate the clinical features and laboratory results of insulin autoimmune syndrome induced by clopidogrel and to improve the current understanding of underlying mechanism of insulin autoimmune syndrome. Methods The clinical data, laboratory and imaging results, and diagnosis and treatment process of a patient with clopidogrel-induced insulin autoimmune syndrome who was treated in Guangdong Provincial People's Hospital from August, 2020 to April, 2023 were retrospectively analyzed. Results A male patient was hospitalized twice due to poor mental state, difficulty in falling asleep, and repeated hypoglycemic symptoms, such as dizziness, palpidity, fatigue, cold sweat and blurred vision without obvious causes. Laboratory results showed that patient's blood sugar decreased, while insulin was abnormally elevated, C-peptide was elevated, and anti-insulin autoantibodies were positive. After diagnosis and differential diagnosis process, the patient was confirmed with insulin autoimmune syndrome. During the first hospitalization, the patient was treated with hormone prednisone tablets without symptoms of hypoglycemia, and during the second hospitalization, it was confirmed that clopidogrel was the main cause of insulin autoimmune syndrome. Clopidogrel was then discontinued and hormone prednisone tablets were used to treat normal blood glucose. Conclusion Clopidogrel-induced insulin autoimmune syndrome is rare, and it is mostly manifested by repeated symptoms of hypoglycemia, which are relieved after eating. Discontinuation of the induced medication and combination of hormone therapy show a better patient response.

关 键 词：氯吡格雷 胰岛素自身免疫综合征 低血糖 

分 类 号：R593.2[医药卫生—内科学]