外源性胰岛素抗体综合征和随后严重的皮下胰岛素抵抗使得1型糖尿病复杂化
Vicki Cunningham1, Leo Lam2,3, Kuang-Chih Hsiao4,5
1Department of Paediatrics, Te Whatu Ora-Health New Zealand, Whangarei 0148, New Zealand.
JCEM case reports
|December 31, 2025
概括
一个患有1型糖尿病的女孩出现了外源性胰岛素抗体综合征 (EIAS),后来出现了严重的皮下胰岛素抵抗 (SIR). 利图西马布最初帮助了EIAS,而肝素后来管理了SIR,显示了这些罕见疾病的独特治疗反应.
科学领域:
- 内分泌学 在内分泌学.
- 免疫学 免疫学 免疫学
- 代谢障碍 代谢障碍 代谢障碍
背景情况:
- 1型糖尿病 (T1D) 管理可能因罕见的自身免疫并发症而复杂化.
- 外源胰岛素抗体综合征 (EIAS) 和严重皮下胰岛素耐药性 (SIR) 是影响胰岛素治疗的异常罕见的疾病.
- 这一案例突出了患有EIAS和SIR的年轻患者的诊断挑战和多样化的治疗反应.
研究的目的:
- 描述一种罕见的EIAS病例和随后的SIR病例的临床过程和治疗方法,该病例发生在患有T1D的年轻女孩身上.
- 评估EIAS和SIR不同治疗方式的有效性.
- 强调这些独特的,尽管相关的,罕见的疾病所需的独特治疗策略.
主要方法:
- 基于临床表现 (高血糖症,症,夜间低血糖症),排除其他原因,并确认高胰岛素自身抗体和结合胰岛素的基础上诊断EIAS.
- 治疗试验包括胰岛素类似物,胰岛素疗法,皮质类固醇,静脉注射免疫球蛋白和EIAS的修复剂.
- 随后的SIR治疗涉及静脉注射胰岛素,并最终与肝素同时使用皮下胰岛素.
主要成果:
- 最初的EIAS呈现对传统治疗不耐药,但对Rituximab (B-淋巴细胞耗尽疗法) 有显著的反应,使胰岛素抗体水平正常化并改善低血糖症.
- 在EIAS缓解后,患者出现了SIR,需要转向静脉注射胰岛素,后来进行专门的皮下方案.
- 最终通过将肝素添加到皮下胰岛素治疗中,成功控制了SIR,从而预防了败血症和线路并发症.
结论:
- EIAS和SIR是T1D中罕见但严重的并发症,需要谨慎诊断和量身定制的管理.
- 利图西马布通过减少胰岛素自身抗体,在治疗EIAS方面表现出有效性.
- 除了皮下胰岛素治疗外,肝素在治疗严重的皮下胰岛素耐药性方面被证明是有效的,为罕见的内分泌免疫疾病展示了可适应的治疗策略.
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