甘精胰岛素诱发的外源性胰岛素自身抗体综合征1例报告

A Case Report of Exogenous Insulin Autoimmune Syndrome Induced by Insulin Glargine

摘要: 回顾我院收治的1例T2DM患者使用甘精胰岛素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24小时血糖监测，示血糖波动大，胰岛素和C-P浓度明显分离现象，IAA阳性。停用胰岛素后改用阿卡波糖、达格列净，随诊3月，低血糖发作减少至停止，胰岛素及C-P水平明显下降，IAA仍为阳性。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: This is a review of a case of autoimmune insulin syndrome (EIAS) induced by insulin glargine in a T2DM patient admitted to our hospital, analyzing the clinical diagnosis and treatment process, including laboratory tests, differential diagnosis, treatment, and prognosis. After discontinuing insulin, the patient underwent 24-hour blood glucose monitoring, which showed significant blood glucose fluctuations and a marked dissociation between insulin and C-peptide levels, with IAA testing positive. Following the cessation of insulin therapy, the patient was switched to acarbose and dapagliflozin. Over a three-month follow-up, hypoglycemic episodes decreased and eventually stopped, insulin and C-peptide levels significantly declined, and IAA remained positive. EIAS is a relatively rare endocrine disorder with specific clinical manifestations. For diabetic patients with hyperinsulinemic hypoglycemia, testing for IAA can help improve diagnostic accuracy. Early diagnosis and appropriate treatment can prevent unnecessary surgeries and severe adverse outcomes resulting from misdiagnosis. Even if IAA is negative, EIAS cannot be completely ruled out; follow-up observation or testing via different methods can also aid in diagnosis.