外源性胰岛素自身免疫综合征十例临床分析

目的　探讨外源性胰岛素自身免疫综合征（EIAS）的临床特点，结合文献了解其临床诊治过程及特点，提高临床医生对该病的诊疗技能。方法　回顾性分析2010年1月-2019年3月内蒙古医科大学内分泌科确诊的10例EIAS患者的一般资料、实验室检查结果、治疗及预后等情况。结果　10例患者中男5例、女5例，年龄35~83岁，糖尿病病程7~23年，低血糖发作多为空腹低血糖，均有长期胰岛素治疗史。患者合并自身免疫疾病情况为湿疹性皮炎1例、银屑病1例。抗体检测结果显示血清胰岛素细胞抗体（ICA）、谷氨酸脱羧酶抗体（GAD）均阴性，胰岛素自身抗体（IAA）阳性10例。血清胰岛素水平均显著升高，与血清C肽水平不匹配。8例患者停用胰岛素，其中6例改为口服降糖药，1例低血糖后出现昏迷，给予甲泼尼龙静脉滴注，1例改变饮食习惯。其余2例患者更换胰岛素剂型，同时加用拜糖平。10例患者治疗后分别于2周~5个月无低血糖发作。结论　长期使用胰岛素的糖尿病患者，出现反复发作、严重的自发性低血糖，胰岛素水平显著升高，且与血清C肽水平不匹配、IAA阳性时，临床应考虑EIAS的诊断。治疗上停用原有胰岛素，或更换胰岛素剂型，病情严重者给予糖皮质激素，患者预后良好。

Clinical Analysis of Ten Cases with Exogenous Insulin Autoimmune Syndrome

Objective To investigate the clinical characteristics of exogenous insulin autoimmune syndrome(EIAS),to understand clinical diagnosis and treatment process and its characteristics of EIAS in combination with literature,and to improve clinicians’skills in diagnosis and treatment of the disease.Methods From January 2010 to March 2019,ten patients with EIAS diagnosed in the Department of Endocrinology of Affiliated Hospital of Inner Mongolia Medical University were selected.A retrospective summary of the patient’s general condition,laboratory examination,treatment and prognosis was made.Results There were 5 males and 5 females aged 35-83 years with diabetes mellitus of 7-23 years.The onset of hypoglycemia was mostly fasting hypoglycemia.All cases had a long history of insulin therapy.The combined immune diseases were eczema-like rash in one case,psoriasis in one case.Antibody test results showed that serum islet cell antibody(ICA),antibody of glutamic acid decarboxylase(GAD)were negative,insulin autoantibody(IAA)was positive in ten cases.At the same time,the serum insulin levels were significantly increased and inconsistent with C-peptide level.Eight patients stopped insulin treatment,six of whom changed to oral hypoglycemic drugs,one was given intravenous infusion of Methylpredation because of coma after hypoglycemia and one changed diet.The other two patients were replaced with the insulin dosage form and added with Butanpine at the same time.No hypoglycemia occurred in ten patients from 2 weeks to 5 months after treatment.Conclusion Diabetic patients with long-term insulin use have recurrent episodes,severe spontaneous hypoglycemia,and significantly increased insulin levels,which are inconsistent with C-peptide level.When IAA is positive,the diagnosis of EIAS should be considered.They should stop using insulin,or change insulin dosage form,and severe patients should be given glucocorticoid therapy.Patients with EIAS have a good prognosis.