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外源性胰岛素自身免疫综合征的个案报道及文献分析
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| 篇名： | 外源性胰岛素自身免疫综合征的个案报道及文献分析 |
| TITLE： | Care report and literature analysis of exogenous insulin autoimmune syndrome |
| 摘要： | 目的 通过1例外源性胰岛素自身免疫综合征（EIAS）的诊疗，结合文献报道资料的分析，探讨药学监护的意义。方法临床药师参与1例EIAS的诊疗过程，结合病情特点，提出用药建议，制定药学监护措施。同时，检索胰岛素自身免疫综合征（IAS）和EIAS相关文献，提取数据（性别、年龄、发生时间、实验室检查、临床症状、干预及转归）并进行分析。结果临床药师根据患者近3年的用药信息，判断EIAS很可能是由门冬胰岛素30引起的；临床医师采纳临床药师建议，停用胰岛素、换用口服药物降糖，该患者经治疗后好转。文献分析显示，报道的IAS共257例患者，212例由药物引起；其中硫辛酸致IAS23例，外源性胰岛素致EIAS56例，两组患者年龄、糖化血红蛋白、体重指数无显著性差异，硫辛酸组最低血糖明显低于外源性胰岛素组（P＜0.05），女性占比及空腹胰岛素≥1000μU/mL的占比明显高于外源性胰岛素组（P＜0.05）。结论相比于EIAS，硫辛酸致IAS通常会引起更严重的低血糖，空腹胰岛素水平通常大于1000μU/mL，且更常见于女性患者。临床药师参与EIAS的诊疗，有助于提高同类罕见疾病的诊治水平，保障患者用药安全。 |
| ABSTRACT： | OBJECTIVE To explore the significance of pharmaceutical care through the diagnosis and treatment of a patient with exogenous insulin autoimmune syndrome （EIAS）， combined with the analysis of literature reports. METHODS Clinical pharmacist participated in the diagnosis and treatment process of one case of EIAS. Based on the characteristics of the patient’s condition， the pharmacist provided medication suggestions and formulated pharmaceutical monitoring measures. At the same time， the pharmacist searched for relevant literature on insulin autoimmune syndrome （IAS） and EIAS， extracted data （gender， age， occurrence time， laboratory tests， clinical symptoms， intervention and outcome）， and conducted analysis. RESULTS Based on the patient’s medication information in the past 3 years， clinical pharmacist determined that the EIAS was likely caused by insulin aspartate 30. The clinician adopted the clinical pharmacist’s suggestion to discontinue insulin and switch to oral hypoglycemic drugs. The patient improved after treatment. The literature analysis showed that among the 257 patients with IAS reported， 212 cases were caused by drugs； among them， 23 cases were caused by lipoic acid， and 56 cases were caused by exogenous insulin. There were no significant differences in age， glycosylated hemoglobin， and body mass index between the two groups. The lowest blood glucose level in the lipoic acid group was significantly lower than that in the exogenous insulin group （P＜0.05）. The proportion of females and the proportion of fasting insulin ≥ 1 000 μU/mL were significantly higher in the lipoic acid group than in the exogenous insulin group （P＜0.05）. CONCLUSIONS Compared with EIAS， lipoic acid-induced IAS usually causes more severe hypoglycemia， and the fasting insulin level is usually higher than 1 000 μU/mL， which is more common in female patients. The participation of clinical pharmacists in the diagnosis and treatment of EIAS can help improve the diagnosis and treatment level of similar rare diseases and ensure the safety of patients’ medication. |
| 期刊： | 2025年第36卷第15期 |
| 作者： | 王玉娟；李全志；王敬；朱梦原；郝晓飞；程杰 |
| AUTHORS： | WANG Yujuan，LI Quanzhi，WANG Jing，ZHU Mengyuan，HAO Xiaofei，CHENG Jie |
| 关键字： | 胰岛素自身免疫综合征；硫辛酸；胰岛素；低血糖 |
| KEYWORDS： | insulin autoimmune syndrome； lipoic acid； insulin； hypoglycemia |
| 阅读数： | 15 次 |
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