胰岛素自身免疫综合征2例病例报告
发布时间：2019-03-12 09:21
【摘要】：背景和目的随着我国社会的老龄化,生活水平的提高和生活方式的改变,糖尿病的发病率持续上升。目前全球范围内糖尿病患者人数占到8.8%,截至2015年全球糖尿病数量已达4.15亿,而我国糖尿病人数为1.09亿,患病率已达11.6%,是全球拥有最多糖尿病患者的国家。低血糖是糖尿病患者治疗中常见的并发症。低血糖比高血糖的即刻危害更甚,严重者可出现昏迷,可造成大脑皮层细胞不可逆的损伤,还可以导致休克,诱发心绞痛、心肌梗塞或脑梗塞等,发病急,变化快,如不能及时察觉可致患者的死亡,严重威胁着糖尿病患者的生命安全。低血糖的原因有很多,胰岛素自身免疫综合征(I AS,Insulin autoimmune syndrome)是引起患者反复低血糖的重要疾病之一,临床上较少见,容易漏诊或误诊,导致延误治疗。特别是在糖尿病患者中的IAS,由于降糖药物及胰岛素的使用,更是难以及时诊断,合理治疗。本文通过分析2例糖尿病合并IAS患者的临床资料,探讨该疾病的发病机制、临床特点、诊断及治疗等,以提高对该疾病的认识,有助于对该病早期诊断及治疗,减少漏诊和误诊。方法收集2011年1月1日至2016年12月31日期间收治的2例使用胰岛素治疗的糖尿病患者合并IAS的临床病例资料,分析患者的既往史、临床症状、实验室和影像学检查结果,以及治疗经过,通过回顾相关文献,阐述本病的特点及诊疗进展。结果2例糖尿病患者在治疗中反复出现低血糖发作,发作时血糖水平均≤3.9mmol/L;实验室检查发现血胰岛素水平不恰当升高,且倍数远远超过同步C肽升高的倍数,临床诊断首先考虑IAS,给予对应治疗,1例停用胰岛素治疗,1例用激素治疗,血糖均控制可,后期随访一年均未再发作低血糖。不足之处在于发病期间未反复测定IAA(Insulin autoantibody),增加IAA的检出率,后期随访期间未复查IAA,也没有在治疗前后进行IAA的定量检测,不利于评估IAA是否转阴,不利于IAS的诊断,和是否起始激素治疗,以及激素治疗的疗效和疗程的评估;以及诱发因素不能确定,研究病例数太少,治疗经验和参考文献少,需要增加病例积累经验。结论通过报告我院收治的2例IAS病例,详细介绍了病例的临床表现,病情变化,实验室及影像检查结果,治疗情况及转归,结合文献复习,讨论了 IAS的研究现状和相关鉴别诊断,对此类病例进行归纳总结,以提高对该类疾病的认识。
[Abstract]:Background and objective With the aging of our society, the improvement of living standard and the change of the way of life, the incidence of diabetes continues to rise. At present, the number of patients with diabetes worldwide accounts for 8.8%. As of 2015, the number of diabetes in the world has reached 4.15 billion, and the number of diabetes in China is 1.09 billion, and the prevalence rate has reached 11.6%, which is the country with the largest number of diabetes patients in the world. Hypoglycemia is a common complication in the treatment of diabetic patients. The hypoglycemia is more acute than that of hyperglycemia, a coma can occur in the serious person, the irreversible damage of the cerebral cortex cells can be caused, the shock can be induced, the angina pectoris, the myocardial infarction or the cerebral infarction and the like can be induced, the incidence is rapid, the change is fast, and the death of the patient can not be detected in time, And the life safety of the diabetic patients is seriously threatened. The causes of hypoglycaemia are many, and the insulin autoimmunity syndrome (I AS, Inulin autoamune syndrome) is one of the most important diseases that cause the patient to repeat hypoglycaemia. In particular, the IAS in the diabetic patients is difficult to diagnose in time due to the use of the hypoglycemic agent and the insulin, and the treatment is reasonable. This paper, through the analysis of the clinical data of 2 patients with diabetes mellitus (IAS), discusses the pathogenesis, clinical features, diagnosis and treatment of the disease, so as to raise the understanding of the disease, and help to diagnose and treat the disease early, and to reduce the missed diagnosis and misdiagnosis. Methods Two patients with diabetes mellitus treated with insulin were collected from January 1,2011 to December 31,2016, and the clinical case data of the IAS were analyzed, and the prior history, clinical symptoms, laboratory and imaging findings of the patient were analyzed, and the relevant literature was reviewed. The characteristics of this disease and the progress of diagnosis and treatment are described. Results In 2 patients with diabetes, the onset of hypoglycaemia was repeated in the treatment, the blood glucose level was 3.9 mmol/ L at the time of the attack, and the level of blood insulin in the laboratory was not increased properly, and the multiple was much higher than that of the synchronous C-peptide. The clinical diagnosis first considered the IAS. The corresponding treatment was given, one case was treated with insulin, one case was treated with hormone, and the blood sugar was controlled. The deficiency of the invention is that IAA (Inulin autoantibody) is not measured repeatedly during the disease, the detection rate of the IAA is increased, the IAA is not rechecked during the later-up follow-up period, and the quantitative detection of the IAA is not performed before and after the treatment, and the method is not beneficial to the evaluation of whether the IAA is turned negative, is not beneficial to the diagnosis of the IAS, and whether the hormone therapy is started, And the assessment of the efficacy and course of treatment of the hormone therapy; and the failure to determine the inducing factors, the number of the study cases is too small, the treatment experience and the reference are small, and the case accumulation experience is needed to be increased. The clinical manifestation, the change of the condition, the laboratory and the image examination results, the treatment and the outcome of the cases were described in detail through the report of 2 cases of IAS in our hospital, and the status of the study and the relevant differential diagnosis of the IAS were discussed in detail in the literature review, and the cases were concluded and summarized. In order to raise awareness of such diseases.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R593.2
，
本文编号：2438653
[Abstract]:Background and objective With the aging of our society, the improvement of living standard and the change of the way of life, the incidence of diabetes continues to rise. At present, the number of patients with diabetes worldwide accounts for 8.8%. As of 2015, the number of diabetes in the world has reached 4.15 billion, and the number of diabetes in China is 1.09 billion, and the prevalence rate has reached 11.6%, which is the country with the largest number of diabetes patients in the world. Hypoglycemia is a common complication in the treatment of diabetic patients. The hypoglycemia is more acute than that of hyperglycemia, a coma can occur in the serious person, the irreversible damage of the cerebral cortex cells can be caused, the shock can be induced, the angina pectoris, the myocardial infarction or the cerebral infarction and the like can be induced, the incidence is rapid, the change is fast, and the death of the patient can not be detected in time, And the life safety of the diabetic patients is seriously threatened. The causes of hypoglycaemia are many, and the insulin autoimmunity syndrome (I AS, Inulin autoamune syndrome) is one of the most important diseases that cause the patient to repeat hypoglycaemia. In particular, the IAS in the diabetic patients is difficult to diagnose in time due to the use of the hypoglycemic agent and the insulin, and the treatment is reasonable. This paper, through the analysis of the clinical data of 2 patients with diabetes mellitus (IAS), discusses the pathogenesis, clinical features, diagnosis and treatment of the disease, so as to raise the understanding of the disease, and help to diagnose and treat the disease early, and to reduce the missed diagnosis and misdiagnosis. Methods Two patients with diabetes mellitus treated with insulin were collected from January 1,2011 to December 31,2016, and the clinical case data of the IAS were analyzed, and the prior history, clinical symptoms, laboratory and imaging findings of the patient were analyzed, and the relevant literature was reviewed. The characteristics of this disease and the progress of diagnosis and treatment are described. Results In 2 patients with diabetes, the onset of hypoglycaemia was repeated in the treatment, the blood glucose level was 3.9 mmol/ L at the time of the attack, and the level of blood insulin in the laboratory was not increased properly, and the multiple was much higher than that of the synchronous C-peptide. The clinical diagnosis first considered the IAS. The corresponding treatment was given, one case was treated with insulin, one case was treated with hormone, and the blood sugar was controlled. The deficiency of the invention is that IAA (Inulin autoantibody) is not measured repeatedly during the disease, the detection rate of the IAA is increased, the IAA is not rechecked during the later-up follow-up period, and the quantitative detection of the IAA is not performed before and after the treatment, and the method is not beneficial to the evaluation of whether the IAA is turned negative, is not beneficial to the diagnosis of the IAS, and whether the hormone therapy is started, And the assessment of the efficacy and course of treatment of the hormone therapy; and the failure to determine the inducing factors, the number of the study cases is too small, the treatment experience and the reference are small, and the case accumulation experience is needed to be increased. The clinical manifestation, the change of the condition, the laboratory and the image examination results, the treatment and the outcome of the cases were described in detail through the report of 2 cases of IAS in our hospital, and the status of the study and the relevant differential diagnosis of the IAS were discussed in detail in the literature review, and the cases were concluded and summarized. In order to raise awareness of such diseases.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R593.2
，
本文编号：2438653
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