胰島素自身免疫綜合征2例病例報告
發(fā)布時間：2019-03-12 09:21
【摘要】：背景和目的隨著我國社會的老齡化,生活水平的提高和生活方式的改變,糖尿病的發(fā)病率持續(xù)上升。目前全球范圍內(nèi)糖尿病患者人數(shù)占到8.8%,截至2015年全球糖尿病數(shù)量已達4.15億,而我國糖尿病人數(shù)為1.09億,患病率已達11.6%,是全球擁有最多糖尿病患者的國家。低血糖是糖尿病患者治療中常見的并發(fā)癥。低血糖比高血糖的即刻危害更甚,嚴重者可出現(xiàn)昏迷,可造成大腦皮層細胞不可逆的損傷,還可以導(dǎo)致休克,誘發(fā)心絞痛、心肌梗塞或腦梗塞等,發(fā)病急,變化快,如不能及時察覺可致患者的死亡,嚴重威脅著糖尿病患者的生命安全。低血糖的原因有很多,胰島素自身免疫綜合征(I AS,Insulin autoimmune syndrome)是引起患者反復(fù)低血糖的重要疾病之一,臨床上較少見,容易漏診或誤診,導(dǎo)致延誤治療。特別是在糖尿病患者中的IAS,由于降糖藥物及胰島素的使用,更是難以及時診斷,合理治療。本文通過分析2例糖尿病合并IAS患者的臨床資料,探討該疾病的發(fā)病機制、臨床特點、診斷及治療等,以提高對該疾病的認識,有助于對該病早期診斷及治療,減少漏診和誤診。方法收集2011年1月1日至2016年12月31日期間收治的2例使用胰島素治療的糖尿病患者合并IAS的臨床病例資料,分析患者的既往史、臨床癥狀、實驗室和影像學檢查結(jié)果,以及治療經(jīng)過,通過回顧相關(guān)文獻,闡述本病的特點及診療進展。結(jié)果2例糖尿病患者在治療中反復(fù)出現(xiàn)低血糖發(fā)作,發(fā)作時血糖水平均≤3.9mmol/L;實驗室檢查發(fā)現(xiàn)血胰島素水平不恰當升高,且倍數(shù)遠遠超過同步C肽升高的倍數(shù),臨床診斷首先考慮IAS,給予對應(yīng)治療,1例停用胰島素治療,1例用激素治療,血糖均控制可,后期隨訪一年均未再發(fā)作低血糖。不足之處在于發(fā)病期間未反復(fù)測定IAA(Insulin autoantibody),增加IAA的檢出率,后期隨訪期間未復(fù)查IAA,也沒有在治療前后進行IAA的定量檢測,不利于評估IAA是否轉(zhuǎn)陰,不利于IAS的診斷,和是否起始激素治療,以及激素治療的療效和療程的評估;以及誘發(fā)因素不能確定,研究病例數(shù)太少,治療經(jīng)驗和參考文獻少,需要增加病例積累經(jīng)驗。結(jié)論通過報告我院收治的2例IAS病例,詳細介紹了病例的臨床表現(xiàn),病情變化,實驗室及影像檢查結(jié)果,治療情況及轉(zhuǎn)歸,結(jié)合文獻復(fù)習,討論了 IAS的研究現(xiàn)狀和相關(guān)鑒別診斷,對此類病例進行歸納總結(jié),以提高對該類疾病的認識。
[Abstract]:Background and objective With the aging of our society, the improvement of living standard and the change of the way of life, the incidence of diabetes continues to rise. At present, the number of patients with diabetes worldwide accounts for 8.8%. As of 2015, the number of diabetes in the world has reached 4.15 billion, and the number of diabetes in China is 1.09 billion, and the prevalence rate has reached 11.6%, which is the country with the largest number of diabetes patients in the world. Hypoglycemia is a common complication in the treatment of diabetic patients. The hypoglycemia is more acute than that of hyperglycemia, a coma can occur in the serious person, the irreversible damage of the cerebral cortex cells can be caused, the shock can be induced, the angina pectoris, the myocardial infarction or the cerebral infarction and the like can be induced, the incidence is rapid, the change is fast, and the death of the patient can not be detected in time, And the life safety of the diabetic patients is seriously threatened. The causes of hypoglycaemia are many, and the insulin autoimmunity syndrome (I AS, Inulin autoamune syndrome) is one of the most important diseases that cause the patient to repeat hypoglycaemia. In particular, the IAS in the diabetic patients is difficult to diagnose in time due to the use of the hypoglycemic agent and the insulin, and the treatment is reasonable. This paper, through the analysis of the clinical data of 2 patients with diabetes mellitus (IAS), discusses the pathogenesis, clinical features, diagnosis and treatment of the disease, so as to raise the understanding of the disease, and help to diagnose and treat the disease early, and to reduce the missed diagnosis and misdiagnosis. Methods Two patients with diabetes mellitus treated with insulin were collected from January 1,2011 to December 31,2016, and the clinical case data of the IAS were analyzed, and the prior history, clinical symptoms, laboratory and imaging findings of the patient were analyzed, and the relevant literature was reviewed. The characteristics of this disease and the progress of diagnosis and treatment are described. Results In 2 patients with diabetes, the onset of hypoglycaemia was repeated in the treatment, the blood glucose level was 3.9 mmol/ L at the time of the attack, and the level of blood insulin in the laboratory was not increased properly, and the multiple was much higher than that of the synchronous C-peptide. The clinical diagnosis first considered the IAS. The corresponding treatment was given, one case was treated with insulin, one case was treated with hormone, and the blood sugar was controlled. The deficiency of the invention is that IAA (Inulin autoantibody) is not measured repeatedly during the disease, the detection rate of the IAA is increased, the IAA is not rechecked during the later-up follow-up period, and the quantitative detection of the IAA is not performed before and after the treatment, and the method is not beneficial to the evaluation of whether the IAA is turned negative, is not beneficial to the diagnosis of the IAS, and whether the hormone therapy is started, And the assessment of the efficacy and course of treatment of the hormone therapy; and the failure to determine the inducing factors, the number of the study cases is too small, the treatment experience and the reference are small, and the case accumulation experience is needed to be increased. The clinical manifestation, the change of the condition, the laboratory and the image examination results, the treatment and the outcome of the cases were described in detail through the report of 2 cases of IAS in our hospital, and the status of the study and the relevant differential diagnosis of the IAS were discussed in detail in the literature review, and the cases were concluded and summarized. In order to raise awareness of such diseases.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1;R593.2
，
本文編號：2438653
[Abstract]:Background and objective With the aging of our society, the improvement of living standard and the change of the way of life, the incidence of diabetes continues to rise. At present, the number of patients with diabetes worldwide accounts for 8.8%. As of 2015, the number of diabetes in the world has reached 4.15 billion, and the number of diabetes in China is 1.09 billion, and the prevalence rate has reached 11.6%, which is the country with the largest number of diabetes patients in the world. Hypoglycemia is a common complication in the treatment of diabetic patients. The hypoglycemia is more acute than that of hyperglycemia, a coma can occur in the serious person, the irreversible damage of the cerebral cortex cells can be caused, the shock can be induced, the angina pectoris, the myocardial infarction or the cerebral infarction and the like can be induced, the incidence is rapid, the change is fast, and the death of the patient can not be detected in time, And the life safety of the diabetic patients is seriously threatened. The causes of hypoglycaemia are many, and the insulin autoimmunity syndrome (I AS, Inulin autoamune syndrome) is one of the most important diseases that cause the patient to repeat hypoglycaemia. In particular, the IAS in the diabetic patients is difficult to diagnose in time due to the use of the hypoglycemic agent and the insulin, and the treatment is reasonable. This paper, through the analysis of the clinical data of 2 patients with diabetes mellitus (IAS), discusses the pathogenesis, clinical features, diagnosis and treatment of the disease, so as to raise the understanding of the disease, and help to diagnose and treat the disease early, and to reduce the missed diagnosis and misdiagnosis. Methods Two patients with diabetes mellitus treated with insulin were collected from January 1,2011 to December 31,2016, and the clinical case data of the IAS were analyzed, and the prior history, clinical symptoms, laboratory and imaging findings of the patient were analyzed, and the relevant literature was reviewed. The characteristics of this disease and the progress of diagnosis and treatment are described. Results In 2 patients with diabetes, the onset of hypoglycaemia was repeated in the treatment, the blood glucose level was 3.9 mmol/ L at the time of the attack, and the level of blood insulin in the laboratory was not increased properly, and the multiple was much higher than that of the synchronous C-peptide. The clinical diagnosis first considered the IAS. The corresponding treatment was given, one case was treated with insulin, one case was treated with hormone, and the blood sugar was controlled. The deficiency of the invention is that IAA (Inulin autoantibody) is not measured repeatedly during the disease, the detection rate of the IAA is increased, the IAA is not rechecked during the later-up follow-up period, and the quantitative detection of the IAA is not performed before and after the treatment, and the method is not beneficial to the evaluation of whether the IAA is turned negative, is not beneficial to the diagnosis of the IAS, and whether the hormone therapy is started, And the assessment of the efficacy and course of treatment of the hormone therapy; and the failure to determine the inducing factors, the number of the study cases is too small, the treatment experience and the reference are small, and the case accumulation experience is needed to be increased. The clinical manifestation, the change of the condition, the laboratory and the image examination results, the treatment and the outcome of the cases were described in detail through the report of 2 cases of IAS in our hospital, and the status of the study and the relevant differential diagnosis of the IAS were discussed in detail in the literature review, and the cases were concluded and summarized. In order to raise awareness of such diseases.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1;R593.2
，
本文編號：2438653
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