摘要
目的探讨胰岛素自身免疫综合征(IAS)的临床特点,提高对本病的诊治能力。方法回顾性总结北京协和医院内分泌科收治的5例IAS患者的性别、发病年龄、病程、低血糖发作时间、病因、实验室检查(包括血糖、C肽、胰岛素、胰岛素自身抗体,5h75g口服葡萄糖耐量试验)结果,以及治疗和预后情况。结果 5例IAS患者中男2例,女3例;年龄39～59岁。病程10d～1年,低血糖发作时间没有规律;1例有Graves病史,2例有含巯基药物接触史(甲巯咪唑1例,硫普罗宁1例),3例无明显诱因发生IAS;血清胰岛细胞抗体、谷氨酸脱羧酶抗体均阴性,胰岛素自身抗体均阳性。口服葡萄糖耐量试验结果显示糖尿病1例,糖耐量受损3例,糖耐量正常1例。同时测定的血清胰岛素水平均显著升高,并与C肽水平不匹配。结论 IAS为少见的内分泌疾病,临床上对高胰岛素性低血糖症患者,如果检测血清胰岛素浓度与C肽水平不匹配,应检测胰岛素自身抗体,以避免误诊和不必要的手术。
Objective To investigate the clinical characteristics of insulin autoimmune syndrome （IAS） and then improve the diagnosis and therapy of this disease. Methods The features of five patients diagnosed with IAS in Peking U-nion Medical College Hospital were retrospectively analyzed, including the sex, age, course of disease, onset time of hypo-glycemia, etiology, laboratory examination results （blood glucose, serum C peptide, insulin levels, insulin autoantibody, 5 h 75 g oral glucose tolerance test）, therapy and prognosis. Results The male-female ratio of these five patients was 2：3; age was between 39 and 59 years old; the course of disease was from 10 days to 1 year; there was no regular pattern of the onset time of hypoglycemia; one patient with the history of Graves disease, two patients once using the drugs containing the sulfydryl group （one with thiamazole, one with tiopronin）, the other 3 patients without known reasons; the serum insulin cell antibody and glutamic acid decarboxylase antibody were all negative, insulin autoantibody were all positive; the results of OGTr showed that 1 patient with diabetes mellitus, three with IGT, one with normal glucose tolerance; but the serum in-sulin levels were very high in all these 5 patients, disproportional with the serum C peptide levels. Conclusion IAS is a rare endocrinology disease. In hypoglycemic patients with high insulin level and disproportionate with serum C pep-tide level, insulin autoantibody detection is mandatory to avoid misdiagnosis and unnecessary surgery.
出处
《北京医学》
CAS
2013年第2期94-98,共5页
Beijing Medical Journal
