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

摘要： 目的　分析胰岛素自身免疫综合征（IAS）的临床特点，结合文献提高对本病的认识。方法　经郑州大学第一附属医院病案室计算机检索2007年1月—2017年5月内分泌与代谢病科确诊为IAS的患者共10例，回顾性总结患者的临床特点，包括一般资料、临床症状、既往史、实验室检查及影像学检查、治疗及随访情况。结果　10例IAS患者中男、女各5例；年龄21~74岁，60岁及以上6例；低血糖发作时间多在夜间及凌晨；5例有含巯基药物服用史，3例有胰岛素应用史，2例无明显诱因；口服葡萄糖耐量试验（OGTT）结果提示糖尿病4例，糖耐量受损3例，糖耐量正常1例；10例患者血清胰岛细胞抗体（ICA）及谷氨酸脱羧酶抗体（GADA）均阴性，而胰岛素自身抗体（IAA）均阳性。所有患者血清胰岛素水平明显升高，并与C肽水平升高不匹配。10例患者均予少食多餐、高纤维素低碳水化合物饮食，其中3例患者加用阿卡波糖，6例患者应用糖皮质激素治疗；5例有含巯基药物服用史患者，均停用相应药物，均未再发作低血糖。完成随访9例，失访1例，随访时间为1~12个月，其中8例患者未再出现低血糖症状。结论　IAS为少见的内分泌疾病，尤其在老年人中高发，临床上对高胰岛素血症性低血糖症患者，应常规检测IAA，以避免漏诊、误诊及不必要的手术。

关键词: 自身免疫疾病, 胰岛素抗体, 体征和症状, 历史文献