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回顾我院收治的1例T2DM患者使用诺和锐30后诱发的自身免疫性综合征(EIAS),分析其临床诊治过程,包括实验室检查、鉴别诊断、治疗及预后。患者停用胰岛素后,行5hOGTT,示血糖波动大,胰岛素和C-P浓度明显分离现象。胰岛素自身抗体(IAA)阴性。停用胰岛素后改用阿卡波糖,随诊10月,低血糖发作减少至停止,胰岛素及C-P水平明显下降,但是胰岛素水平仍然高于正常值,随诊10个月后再次外送查IAA阳性。EIAS为较罕见的内分泌疾病,其临床表现具有特异性。对于高胰岛素性低血糖的糖尿病患者,检测IAA有助于提高诊断率及早诊断与正确治疗,可避免误诊所造成的不必要手术及严重不良后果。即使IAA阴性,也不能完全排除EIAS,随访观察或通过不同方法检测亦可辅助诊断。
A retrospective study admitted to our hospital in 1 case of T2DM patients using Noro Rui 30 induced autoimmune syndrome (EIAS), analysis of its clinical diagnosis and treatment process, including laboratory tests, differential diagnosis, treatment and prognosis. Patients disable insulin, line 5hOGTT, showing large fluctuations in blood glucose, insulin and C-P concentrations were significantly separated. Insulin autoantibodies (IAA) negative. After switching off the use of insulin acarbose, followed up in October, hypoglycemia reduced to stop, insulin and CP levels decreased significantly, but the insulin levels are still higher than normal, followed up again after 10 months to send IAA Positive. EIAS is a rare endocrine disease with specific clinical manifestations. For diabetic patients with hyperinsulinemic hypoglycemia, the detection of IAA can help to improve the diagnostic rate of early diagnosis and correct treatment, to avoid unnecessary surgery caused by misdiagnosis and serious adverse consequences. Even if the IAA negative, it can not completely rule out EIAS, follow-up observation or by different methods can also help diagnosis.