1例胰島素自身抗體所致頻發嚴重低血糖的糖尿病患者的循證治療_《中國循證醫學雜志》

作者：

李永恒 ¹ , 呂麗芳 ¹ , 王椿 ¹ , 周曉芳 ² , 鐘莉 ³ , 崔利娜 ¹ ,  冉興無 ¹

1. 四川大學華西醫院內分泌代謝科，糖尿病足診治中心（成都 610041）；2. 玉溪市人民醫院內分泌代謝科（云南玉溪 653100）；3. 成都市龍泉區人民醫院內分泌代謝科（成都 610100）;

關鍵詞：

胰島素自身抗體低血糖糖皮質激素循證治療

DOI：

10.7507/1672-2531.20100389

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目的　針對近期收治的1 例少見胰島素自身抗體（insulin autoantibody，IAA）所致頻發嚴重低血糖的糖尿病患者，檢索當前最佳證據，為臨床合理治療提供依據。
方法　計算機檢索Cochrane 圖書館（2008 年第3 期）、PubMed（1966 ～ 2009.7）、EMbase（1974 ～ 2009.7）、CBM（1978 ～ 2009.7）、CNKI（1976 ～ 2009.7），按證據級別高低查找相關證據，并對所獲證據進行評價。
結果　共檢索到291 篇文獻，無臨床指南和系統評價，也無臨床對照研究。有關臨床治療的文獻共有30 篇，共包括6 種治療措施，其中胰島素聯合類固醇類藥物效果相對較好，副作用發生較低。根據患者意愿和我院實際情況，在應用胰島素控制血糖的基礎上，對該患者短期給予糖皮質激素（強的松）治療，17 天后IAA 滴度從13.3% 降至5.41%，24 天后降至0.62%，血糖水平趨于穩定，未見低血糖發生。隨訪5 個月，病情穩定，血糖控制尚可，未見低血糖發作。
結論　短期給予糖皮質激素治療是治療IAA 所致頻發嚴重低血糖的有效方法。

引用本文： 李永恒,呂麗芳,王椿,周曉芳,鐘莉,崔利娜,冉興無. 1例胰島素自身抗體所致頻發嚴重低血糖的糖尿病患者的循證治療. 中國循證醫學雜志, 2010, 10(2): 223-226. doi: 10.7507/1672-2531.20100389 復制

1.	Fineberg SE, Kawabata TT, Finco-Kent D, et al. Immunological responses to exogenous insulin. Endocr Rev, 2007, 28: 625-652.
2.	Uchigata Y, Hirata Y, Iwamoto Y. Drug-induced insulin autoimmune syndrome. Diabetes Res Clin Pract, 2009, 83(1): e19-20.
3.	Van Haeften TW. Clinical significance of insulin antibodies in insulin-treated diabetic patients. Diabetes Care, 1989, 12: 641-648.
4.	Lahtela JT, Knip M, Paul R, et al. Severe antibody-mediated human insulin resistance: successful treatment with the insulin analog lispro. Diabetes Care, 1997, 20: 71-73.
5.	Asai M, Kodera T, Ishizeki K, et al. Insulin lispro reduces insulin antibodies in a patient with type 2 diabetes with immunological insulin resistance. Diabetes Res Clin Pract, 2003, 61: 89-92.
6.	Dahl-Jorgensen K, Torjesen P, Hanssen KF, et al. Increase in insulin antibodies during continuous subcutaneous insulin infusion and multiple-injection therapy in contrast to conventional treatment. Diabetes,1987, 36: 1-5.
7.	Van Haeften TW, Krom BA, Gerich JE. Prolonged fasting hypoglycemia due to insulin antibodies in patients with non-insulindependent diabetes mellitus: effect of insulin withdrawal on insulinantibody- binding kinetics. Diabetes Care, 1987, 10: 160-163.
8.	Hara K, Tobe K, Uchigata Y, et al. Antibody-mediated insulin resistance treated by cessation of insulin administration. Intern Med, 2000, 39: 143-145.
9.	Virgili F, Frigato F, Magnanini PG, et al. Reduction in insulin antibodies 42 months after transfer from porcine to human monocomponent insulins. Diabetes Res, 1988, 9: 19-20.
10.	Jovanovic-Peterson L, Kitzmiller JL, Peterson CM. Randomized trial of human versus animal species insulin in diabetic pregnant women: improved glycemic control, not fewer antibodies to insulin, influences birth weight. Am J Obstet Gynecol, 1992, 167: 1325-1330.
11.	Ishizuka T, Ogawa S, Mori T, et al. Characteristics of the antibodies of two patients who developed daytime hyperglycemia and morning hypoglycemia because of insulin antibodies. Diabetes Res Clin Pract, 2009, 84(2): e21-23.
12.	Matsuyoshi A, Shimoda S, Tsuruzoe K, et al. A case of slowly progressive type 1 diabetes with unstable glycemic control caused by unusual insulin antibody and successfully treated with steroid therapy. Diabetes Res Clin Pract, 2006, 72: 238-243.
13.	Koyama R, Nakanishi K, Kato M, et al. Hypoglycemia and hyperglycemia due to insulin antibodies against therapeutic human insulin: treatment with double filtration plasmapheresis and prednisolone. Am J Med Sci, 2005, 329: 259-264.
14.	MacLeish SA, Wallace S, Madhun Z, et al. Treatment of hypoglycemia with intramuscular immunoglobulin in insulin dependent-diabetics with insulin antibodies. Journal of Allergy and Clinical Immunology, 2007, 119(1) Suppl 1: S18.
15.	Miyamura N, Murata Y, Taketa K, et al. A case of insulin autoimmune syndrome with HLA DRB1*0404: impact on the hypothesis for the molecular pathogenesis involving the DRB1 molecules. Diabetes Med, 2006, 23: 104-105.

1. Fineberg SE, Kawabata TT, Finco-Kent D, et al. Immunological responses to exogenous insulin. Endocr Rev, 2007, 28: 625-652.
2. Uchigata Y, Hirata Y, Iwamoto Y. Drug-induced insulin autoimmune syndrome. Diabetes Res Clin Pract, 2009, 83(1): e19-20.
3. Van Haeften TW. Clinical significance of insulin antibodies in insulin-treated diabetic patients. Diabetes Care, 1989, 12: 641-648.
4. Lahtela JT, Knip M, Paul R, et al. Severe antibody-mediated human insulin resistance: successful treatment with the insulin analog lispro. Diabetes Care, 1997, 20: 71-73.
5. Asai M, Kodera T, Ishizeki K, et al. Insulin lispro reduces insulin antibodies in a patient with type 2 diabetes with immunological insulin resistance. Diabetes Res Clin Pract, 2003, 61: 89-92.
6. Dahl-Jorgensen K, Torjesen P, Hanssen KF, et al. Increase in insulin antibodies during continuous subcutaneous insulin infusion and multiple-injection therapy in contrast to conventional treatment. Diabetes,1987, 36: 1-5.
7. Van Haeften TW, Krom BA, Gerich JE. Prolonged fasting hypoglycemia due to insulin antibodies in patients with non-insulindependent diabetes mellitus: effect of insulin withdrawal on insulinantibody- binding kinetics. Diabetes Care, 1987, 10: 160-163.
8. Hara K, Tobe K, Uchigata Y, et al. Antibody-mediated insulin resistance treated by cessation of insulin administration. Intern Med, 2000, 39: 143-145.
9. Virgili F, Frigato F, Magnanini PG, et al. Reduction in insulin antibodies 42 months after transfer from porcine to human monocomponent insulins. Diabetes Res, 1988, 9: 19-20.
10. Jovanovic-Peterson L, Kitzmiller JL, Peterson CM. Randomized trial of human versus animal species insulin in diabetic pregnant women: improved glycemic control, not fewer antibodies to insulin, influences birth weight. Am J Obstet Gynecol, 1992, 167: 1325-1330.
11. Ishizuka T, Ogawa S, Mori T, et al. Characteristics of the antibodies of two patients who developed daytime hyperglycemia and morning hypoglycemia because of insulin antibodies. Diabetes Res Clin Pract, 2009, 84(2): e21-23.
12. Matsuyoshi A, Shimoda S, Tsuruzoe K, et al. A case of slowly progressive type 1 diabetes with unstable glycemic control caused by unusual insulin antibody and successfully treated with steroid therapy. Diabetes Res Clin Pract, 2006, 72: 238-243.
13. Koyama R, Nakanishi K, Kato M, et al. Hypoglycemia and hyperglycemia due to insulin antibodies against therapeutic human insulin: treatment with double filtration plasmapheresis and prednisolone. Am J Med Sci, 2005, 329: 259-264.
14. MacLeish SA, Wallace S, Madhun Z, et al. Treatment of hypoglycemia with intramuscular immunoglobulin in insulin dependent-diabetics with insulin antibodies. Journal of Allergy and Clinical Immunology, 2007, 119(1) Suppl 1: S18.
15. Miyamura N, Murata Y, Taketa K, et al. A case of insulin autoimmune syndrome with HLA DRB1*0404: impact on the hypothesis for the molecular pathogenesis involving the DRB1 molecules. Diabetes Med, 2006, 23: 104-105.

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1例胰島素自身抗體所致頻發嚴重低血糖的糖尿病患者的循證治療

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