1例胰岛素自身抗体所致频发严重低血糖的糖尿病患者的循证治疗_《中国循证医学杂志》

作者：

李永恒 ¹ , 吕丽芳 ¹ , 王椿 ¹ , 周晓芳 ² , 钟莉 ³ , 崔利娜 ¹ ,  冉兴无 ¹

1. 四川大学华西医院内分泌代谢科，糖尿病足诊治中心（成都 610041）；2. 玉溪市人民医院内分泌代谢科（云南玉溪 653100）；3. 成都市龙泉区人民医院内分泌代谢科（成都 610100）;

关键词：

胰岛素自身抗体低血糖糖皮质激素循证治疗

DOI：

10.7507/1672-2531.20100389

视频：

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目的　针对近期收治的1 例少见胰岛素自身抗体（insulin autoantibody，IAA）所致频发严重低血糖的糖尿病患者，检索当前最佳证据，为临床合理治疗提供依据。
方法　计算机检索Cochrane 图书馆（2008 年第3 期）、PubMed（1966 ～ 2009.7）、EMbase（1974 ～ 2009.7）、CBM（1978 ～ 2009.7）、CNKI（1976 ～ 2009.7），按证据级别高低查找相关证据，并对所获证据进行评价。
结果　共检索到291 篇文献，无临床指南和系统评价，也无临床对照研究。有关临床治疗的文献共有30 篇，共包括6 种治疗措施，其中胰岛素联合类固醇类药物效果相对较好，副作用发生较低。根据患者意愿和我院实际情况，在应用胰岛素控制血糖的基础上，对该患者短期给予糖皮质激素（强的松）治疗，17 天后IAA 滴度从13.3% 降至5.41%，24 天后降至0.62%，血糖水平趋于稳定，未见低血糖发生。随访5 个月，病情稳定，血糖控制尚可，未见低血糖发作。
结论　短期给予糖皮质激素治疗是治疗IAA 所致频发严重低血糖的有效方法。

引用本文： 李永恒,吕丽芳,王椿,周晓芳,钟莉,崔利娜,冉兴无. 1例胰岛素自身抗体所致频发严重低血糖的糖尿病患者的循证治疗. 中国循证医学杂志, 2010, 10(2): 223-226. doi: 10.7507/1672-2531.20100389 复制

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.

《中国循证医学杂志》

1例胰岛素自身抗体所致频发严重低血糖的糖尿病患者的循证治疗

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《中国循证医学杂志》

1例胰岛素自身抗体所致频发严重低血糖的糖尿病患者的循证治疗

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