胰岛素自身免疫综合征的临床特征比较分析

摘要

目的 探讨中国、日本及非亚洲人群胰岛素自身免疫综合征(insulin autoimmune syndrome,IAS)的临床特点.方法 就解放军总医院收治的9例IAS患者临床特征,与北京协和医院总结的中国病例、日本及非亚洲人群病例进行对比分析.结果 IAS发病无性别差异,发病年龄范围较广,40岁以上人群更易患此病.亚洲IAS者发病前多合并Graves病和服用甲巯咪唑;非亚洲人群多合并风湿或血液系统疾病.IAS临床特点为严重的自发性低血糖发作,血免疫活性胰岛素(immunoreactive insulin,IRI)浓度升高及胰岛素自身抗体(insulin autoantibodies,IAA)阳性.低血糖既可发生在空腹,也可发生在餐后.IAS预后良好,低血糖症状多在1～3月内缓解.IAS的治疗主要包括改善饮食、停用诱发药物,这可使多数日本患者症状缓解,而中国及非亚洲人群更常应用泼尼松口服治疗.结论 IAS临床表现特异,对低血糖合并高胰岛素血症患者测定IAA有助于诊断IAS,本病治疗简单、预后良好,及早诊断和适当治疗可避免不良事件发生.%Objective To analyze the clinical fealures of palienls with insulin autoimmune syndrome in China, Japan and non-Asian population. Methods Compared with the clinical dala among nine cases of insulin autoimmune syndrome who were diagnosed in the General Hospilal of the People's Liberalion Army, domeslic cases summarized by Peking Union Medical College, Japanese cases and non-Asian cases. Results No gender difference was found in the onsel characlerislics of insulin autoimmune syndrome (IAS) . The onsel age was in a wide range and the palienls older lhan 40 years were more frequently seen. Mosl Asian cases were slrongly associated with Graves disease and medications containing the sulfhydryl group, such as thiamazole. Mosl non-Asian cases were associated with rheumatotogic disease and hematotogic disease. IAS was characterized by severe sponlaneous hypoglycemic episodes, elevated insulin levels and posilive insulin autoanlibodies. The episodes of hypoglycemia occurred in both fasling and postprandial slates. The prognosis of IAS was good, and the hypoglycemia always resolved completely in 1 - 3 monlhs. The main trealment of IAS included diel improvement and offending drugs withdrawal, which released most Japanese syndrome. Bui for Chinese and non-Asian cases, they Irealed with oral prednisone more frequently. Conclusion The clinical fealures of IAS are special. To assay insulin autoanlibodies is greally helpful to distinguish IAS from the palients with hypoglycemia and hyperinsulinism. The treatment of IAS is simple and the prognosis is good. The early diagnosis and correct therapy can avoid the episodes of harmful events.