关键词: 自身免疫疾病, 胰岛素抗体, 体征和症状, 历史文献

Abstract: Objective　To improve the awareness of insulin autoimmune syndrome（IAS） by analyzing the clinical characteristics of IAS and combing with relative literatures reviewing.Methods　A total of ten patients with IAS diagnosed by Department of Endocrinology and Metabolism in the First Affiliated Hospital of Zhengzhou University from January 2007 to May 2017，we retrospectively reviewed these patients' clinical features，including general information，clinical symptoms，past history，laboratory tests and imaging studies，treatment and follow-up situation.Results　There were 5 males and 5 females in 10 IAS patients.The age ranged from 21 to 74 years old and 6 patients were over 60 years old.The onset time of hypoglycemia of ten was at night and early morning.Five cases with the history of exposure to mercapto drugs，3 cases with the history of insulin application，the other 2 patients without obvious reasons.The results of OGTT showed that 4 patients with diabetes mellitus，3 with impaired glucose tolerance，1 with normal glucose tolerance.Ten cases of serum insulin cell antibody（ICA） and glutamic acid decarboxylase antibody（GADA） were all negative，while insulin autoimmune antibody（IAA） were all positive.The serum insulin levels were extremly high in all these cases，while the serum C peptide levels were disproportional.Ten patients were given less food，more meals，high cellulose and low carbohydrate diet，3 patients with acarbose，6 patients with glucocorticoid，5 patients who had the history of exposure to mercapto drugs discontinued the corresponding drugs，and all of them no episodes of hypoglycemia occurred.Nine cases were followed up and 1 case were lost.The follow-up time was 1-12 months，and 8 patients had no hypoglycemia symptoms again.Conclusion　IAS is a rare endocrine disease，especially high incidence in the elderly.IAS should be considered in patients with hyperinsulinemic hypoglycemia.Routinely test IAA might be helpful to avoid misdiagnosis and unnecessary surgery.

Key words: Autoimmune diseases, Insulin antibodies, Signs and symptoms, Historical article