外源性胰岛素诱发的胰岛素自身免疫综合征一例诊治分析并文献复习

发布时间：2019-04-07 18:35

【摘要】：回顾我院收治的1例T2DM患者使用诺和锐30后诱发的自身免疫性综合征(EIAS),分析其临床诊治过程,包括实验室检查、鉴别诊断、治疗及预后。患者停用胰岛素后,行5hOGTT,示血糖波动大,胰岛素和C-P浓度明显分离现象。胰岛素自身抗体(IAA)阴性。停用胰岛素后改用阿卡波糖,随诊10月,低血糖发作减少至停止,胰岛素及C-P水平明显下降,但是胰岛素水平仍然高于正常值,随诊10个月后再次外送查IAA阳性。EIAS为较罕见的内分泌疾病,其临床表现具有特异性。对于高胰岛素性低血糖的糖尿病患者,检测IAA有助于提高诊断率及早诊断与正确治疗,可避免误诊所造成的不必要手术及严重不良后果。即使IAA阴性,也不能完全排除EIAS,随访观察或通过不同方法检测亦可辅助诊断。
[Abstract]:The clinical diagnosis and treatment of autoimmune syndrome (T2DM), including laboratory examination, differential diagnosis, treatment and prognosis, were analyzed retrospectively in a case of (EIAS), induced by Nohe Rui 30 in our hospital. After discontinuation of insulin, OGTT for 5 hours showed that the blood glucose fluctuated greatly, and the concentration of insulin and C _ (P) were significantly separated. Insulin autoantibody (IAA) was negative. After insulin was stopped, acarbose was used. After 10 months of follow-up, hypoglycemic attacks were reduced to stop, the levels of insulin and C _ (P) were significantly decreased, but the level of insulin was still higher than the normal level. EIAS was a rare endocrine disease, and its clinical manifestations were specific. IAA was positive after 10 months of follow-up. For diabetic patients with high insulinemia and hypoglycemia, the detection of IAA is helpful to improve the diagnosis rate, to diagnose and treat correctly, and to avoid unnecessary operation and serious adverse consequences caused by misdiagnosis. Even if IAA is negative, EIAS, can not be completely excluded from follow-up observation or by different methods of detection can also assist the diagnosis.
【作者单位】：新疆石河子大学医学院第一附属医院内分泌代谢科;
【基金】：兵团科技攻关成果转化计划项目(2015AD006)
【分类号】：R587.1

【相似文献】